Clinical profile of steroid-induced glaucoma in Bali Mandara Eye Hospital year 2019

Introduction: Glaucoma is an optic neuropathy characterized by optic disc cupping and visual field loss usually associated with raised intraocular pressure. Glaucoma incidence is rapidly increasing, with global incidence is estimated to reach 76 million in 2020. There are many causes of glaucoma; one of them is corticosteroid use. Unmonitored steroid use can be resulting in undesirable side effects such as steroid-induced glaucoma. This study aims to evaluate the clinical profile of steroid-induced glaucoma in Bali Mandara Hospital year 2019.

Method: A descriptive-cross sectional study was conducted using secondary data involving 35 medical records of patients diagnosed with glaucoma in Bali Mandara Eye Hospital, Denpasar, from January to December 2019. Age, gender, steroid type, routes and duration of steroid administration were recorded from medical records. Obtained data were analyzed descriptively using SPSS version 23 for Windows.  

Results: Patient’s characteristics mostly were male 57.14% and 42.86% female, 31.43% were elderly >55 years old. They mostly used eye drops steroid (85.71%), and 14.29% took oral steroids. The most used eye drops were Dexamethasone eye drops (77.14%). For oral steroids, they took Methylprednisolone (8.57%) and Dexamethasone (5.71%). Most of them have symptoms after one year of steroid use (34.39%).

Conclusion: Steroid-induced glaucoma can occur in both males or females in all age groups, which the elderly and children have a higher risk. Most cases occur from topical steroids. Steroid-induced glaucoma is avoidable irreversible blindness. Therefore, the use of steroids must be judicious; self-medication must be avoided. The doctor must provide education to patients who are given steroid therapy.

Nilai diagnostik dari mean platelet volume (MPV) pada sepsis neonatorum di RSUD Wangaya, Denpasar, Bali, Indonesia

Background: Neonatal sepsis is a clinical syndrome of systemic disease with high morbidity and mortality. Early diagnosis of neonatal sepsis is still difficult to be done. A cheap, fast, and accurate septic marker is needed. Several studies of mean platelet volume have been done and are considered as one of the markers that can help diagnose neonatal sepsis early and accurately. The objective of this study is to assess the diagnostic value of MPV in neonatal sepsis.

Methods: This analytic observational study with the diagnostic test was done by collecting secondary data from medical records of neonates with suspicion of neonatal sepsis in Wangaya Hospital, Denpasar, from January 2019 to June 2020.  MPV cut-off point was determined with receiver-operating characteristic (ROC) curve. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MPV in neonatal sepsis were determined using a 2x2 table.

Results: Of 104 sample subjects, 16 subjects (15.4%) were diagnosed with neonatal sepsis. MPV with a cut-off point of 9.95 fl had 62.5% sensitivity, 61.4% specificity, 22% PPV, 90% NPV, and 61% accuracy.

Conclusion: MPV with a cut-off point of 9.95 fl can be used to diagnose neonatal sepsis with a 62.5% sensitivity and a 61.4% specificity.

Latar Belakang: Sepsis neonatorum merupakan sindrom klinik penyakit sistemik yang memiliki angka morbiditas dan mortalitas yang tinggi pada neonatus. Diagnosis sepsis neonatorum masih sulit dilakukan dengan cepat. Diperlukannya alat penanda sepsis yang murah, cepat, dan akurat. Beberapa penelitian mengenai mean platelet volume (MPV) telah dilakukan dan salah satu pilihan pemeriksaan yang diharapkan dapat membantu penegakan diagnosis sepsis neonatorum dengan cepat dan akurat. Tujuan penelitian ini adalah untuk mengetahui nilai diagnostik dari MPV pada sepsis neonatorum.

Metode: Studi observasional analitik dengan uji diagnostik ini dilakukan dengan mengumpulkan data sekunder dari rekam medis neonatus yang dirawat di RSUD Wangaya, Denpasar dengan kecurigaan sepsis neonatorum dari Januari 2019 hingga Juni 2020. Titik potong nilai MPV akan ditentukan menggunakan kurva receiver-operating characteristic (ROC). Nilai sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN), dan akurasi dari nilai MPV pada sepsis neonatorum akan ditentukan menggunakan tabel 2x2.

Hasil: Dari 104 subjek sampel, didapatkan subjek dengan diagnosis sepsis neonatorum sebesar 16 subjek (15.4%). Dengan titik potong MPV sebesar 9,95 fl, didapatkan nilai sensitifitas 62,5%, spesifisitas 61,4%, NDP 22%, NDN 90%, dan akurasi 61%.

Kesimpulan: MPV dengan titik potong 9,95 fl dapat mendiagnosis sepsis neonatorum dengan sensitifitas 62,5% dan spesifisitas 61,4%.

Asam urat serum tinggi dan risiko mortalitas kardiovaskular: sebuah tinjauan sistematik penelitian kohort

Introduction: Serum uric acid has been reported as a predictor of cardiovascular mortality, but there are many debates regarding this finding. This systematic review will analyze and discuss about serum uric acid as an indicator of cardiovascular mortality risk.

Methods: A literature search was carried out on the PubMed and ProQuest databases for publication that focused on the association of serum uric acid and cardiovascular mortality risk within 2015-2020. The preparation of this systematic review is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA).

Results: In this review, four studies were relevant and met the selection criteria. All studies were prospective cohort studies. There were a total of 668,768 participants involved, with a slight female majority (55%). Participants involved in this study were aged 35 years or older. Three of the studies examined showed an association between high serum uric acid levels and cardiovascular disease mortality. Only one study did not show a statistically significant relationship. Each study used a different cut-off point for serum uric acid categories, making the uric acid indicator difficult to apply in clinical practice. The three studies conducted in Asia provide a more practical result that is relevant to the Indonesian population. In all three studies, results were consistent, showing elevated serum uric acid increases cardiovascular mortality risk.

Conclusion: Serum uric acid level can predict the risk of death from cardiovascular disease. The study conducted in Asia is quite relevant to the Indonesian population, where the results of the study significantly and consistently found that high serum uric acid levels can increase the risk of cardiovascular mortality.  

Pendahuluan: Asam urat serum dilaporkan dapat memperkirakan risiko dari mortalitas kardiovaskular, akan tetapi masih terdapat banyak perdebatan terkait temuan tersebut. Dalam tinjauan ini akan dibahas lebih jauh mengenai hubungan asam urat serum terhadap risiko mortalitas kardiovaskular yang disajikan dalam systematic review.

Metode: Pencarian literatur dilakukan pada database PubMed dan ProQuest dengan mengidentifikasi jurnal yang diterbitkan dari tahun 2015-2020 yang berfokus pada topik asam urat serum dan hubungannya terhadap risiko mortalitas kardiovaskular. Penyusunan systematic review ini disusun berdasarkan pedoman Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA).

Hasil: Dalam tinjauan ini terdapat 4 studi yang relevan dan memenuhi kriteria seleksi. Seluruh studi merupakan studi kohort prospektif. Terdapat total 668.768 partisipan yang terlibat dengan persentase perempuan sebesar 55%. Partisipan yang terlibat dalam studi ini berusia 35 tahun atau lebih. Tiga dari empat penelitian yang ditinjau menunjukan adanya hubungan antara kadar asam urat serum yang tinggi dengan kematian akibat penyakit kardiovaskular. Hanya satu penelitian yang tidak menunjukan hubungan yang bermakna secara statistik. Masing-masing penelitian menggunakan titik potong kategori asam urat serum yang berbeda-beda yang menyebabkan efektivitas indikator asam urat serum sulit untuk diaplikasikan. Tiga studi yang dilakukan di Asia memberikan gambaran yang lebih sesuai untuk aplikasi di Indonesia karena populasi partisipannya lebih mendekati keadaan populasi Indonesia.  Pada ketiga studi tersebut diperoleh hasil yang konsisten menunjukan peningkatan asam urat serum meningkatkan risiko mortalitas kardiovaskular.

Kesimpulan: Kadar asam urat serum dapat dapat memperkirakan risiko mortalitas akibat penyakit kardiovaskular. Studi yang dilakukan di Asia, cukup relevan dengan populasi Indonesia, dimana hasil studi ini secara signifikan dan konsisten mendapatkan kadar asam urat serum yang tinggi dapat meningkatkan risiko mortalitas akibat penyakit kardiovaskular.

Hubungan antara terapi statin dengan kadar gula darah puasa dan profil lipid pada pasien coronary artery disease di RSUD Sanjiwani

Background: Statin therapy has an important role to coronary artery disease (CAD) which can lowered cholesterol levels and give pleiotropic effects to inhibit inflammatory reactions. Statin have some side effects and new onset diabetes is one of them, where diabetes is also a risk factor for CAD. This study aims to know the correlation of statin therapy and fasting blood glucose levels of CAD patient in Sanjiwani Hospital.

Methods: The design of this study was analytic cross-sectional study that started from November 17th 2020 until January 31st 2021 in Sanjiwani Hospital. A total of 68 patients were included in this study. The data source of this study was secondary data from patient’s medical record. The inclusion criteria was all CAD patients with statin therapy who had history of fasting blood glucose test that visited cardiology department of Sanjiwani Hospital at year 2020. Normality test, bivariate, and multivariate analysis was done in this study.

Results: Bivariate analysis using Spearman showed a weak positive correlation between duration of statin therapy with fasting blood glucose levels (r=0,353; p= 0,003), and Kruskal Wallis analysis showed no correlation between statin type with fasting blood glucose levels.

Conclusion: Duration of statin therapy has a weak correlation with fasting blood glucose levels so that statin still can be given with concerns to its benefit of reduced mortality. Prevention of new onset diabetes should be done by lifestyle modification and periodic blood glucose monitoring.

Latar Belakang: Terapi statin memiliki peranan penting terhadap coronary artery disease (CAD) yang mampu menurunkan kadar kolesterol serta memberikan efek pleiotropik untuk menghambat reaksi inflamasi. Statin memiliki beberapa efek samping, salah satunya adalah risiko diabetes onset baru dimana diabetes merupakan salah satu faktor risiko CAD. Penelitian ini dilakukan untuk mengetahui hubungan antara terapi statin dengan kadar gula darah puasa pasien CAD di RSUD Sanjiwani.

Metode: Desain penelitian yang digunakan adalah analitik cross-sectional yang dilakukan dari 17 November 2020 sampai 31 Januari 2021 di RSUD Sanjiwani. Sebanyak 68 pasien diikutkan dalam penelitian ini. Sumber data pada penelitian ini berupa data sekunder yang didapatkan dari rekam medis pasien dengan kriteria inklusi yaitu semua pasien CAD dengan terapi statin dan memiliki riwayat pemeriksaan kadar gula darah puasa yang melakukan kontrol di poli jantung RSUD Sanjiwani tahun 2020. Uji normalitas, analisis bivariat, dan multivariat dilakukan pada penelitian ini.

Hasil: Analisis bivariat dengan Spearman menunjukan adanya korelasi positif lemah antara durasi terapi statin dengan kadar gula darah puasa (r=0,353; p= 0,003), sedangkan hasil analisis Kruskall Wallis menunjukan tidak ada korelasi antara jenis statin dengan kadar gula darah puasa.

Simpulan: Durasi terapi statin memiliki hubungan lemah dengan kadar gula darah puasa sehingga terapi statin masih dapat diberikan dengan memperhatikan keuntungan terapi yang lebih besar. Pencegahan terhadap risiko diabetes onset baru tetap dilakukan dengan modifikasi gaya hidup serta pemantauan gula darah berkala.

Kesesuaian hasil pengukuran Low Density Lipoprotein Cholesterol menggunakan persamaan Friedewald, Hopkins, dan Homogeneous Enzymatic Colorimetric Assay di RSUP Sanglah, Bali, Indonesia

Background: LDL-C concentration can be obtained by calculation from equations and measurement methods. There are many LDL-C equations, but the most commonly used is the Friedewald equation, and the most recent is the Hopkins equation. This study aims to determine LDL-C measurements' agreement using the Friedewald equation, Hopkins equation, and homogeneous enzymatic colorimetric assay.

Methods: This was a cross-sectional study, from January-February 2020, with 570 samples LDL-C examination results by Friedewald equation, Hopkins equation, and homogeneous enzymatic colorimetric assay divided into 3 groups based on TG levels. Data were analyzed by SPSS version 17 for Windows.

Results: Spearman correlation test found a near-perfect correlation between LDL-C using Friedewald and Hopkins equations to direct examinations with values r =0.921 and r =0.907. Limit of agreement from the Bland-Altman test shows an average of >90% for both equations with direct measurements. Mann-Whitney test showed a significant difference between LDL-C direct measurement and Friedewald equation in Total Group, TG 200-400 mg/dL and TG> 400 mg/dL while for Hopkins equation only in TG group> 400 mg/dL (p<0.05). Based on Total Allowable Error (TAE) analysis, LDL-C from Hopkins equation in TG group 200-400 mg/dL appears to be superior to the Friedewald equation.

Conclusion: Friedewald equation and Hopkins equation give good concordance at TG levels <200 mg/dL while at triglyceride levels 200-400 mg/dL Hopkins equation gives better concordance than the Friedewald equation. At triglyceride levels,> 400 mg/dL Friedewald and Hopkins equations show low accuracy, so it is recommended to use the direct method.

Latar Belakang: Konsentrasi low density lipoprotein cholesterol (LDL-C) dapat diperoleh dengan 2 cara yaitu menggunakan perhitungan dengan persamaan dan metode pengukuran langsung (direct). Banyak persamaan perhitungan LDL-C tetapi yang paling umum digunakan adalah persamaan Friedewald dan yang terbaru adalah persamaan Hopkins. Penelitian ini bertujuan untuk mengetahui kesesuaian hasil pengukuran LDL-C menggunakan persamaan Friedewald, persamaan Hopkins dan homogeneous enzymatic colorimetric assay

Metode: Penelitian menggunakan rancangan analitik potong lintang dari bulan Januari-Pebruari 2020 dengan 570 sampel hasil pemeriksaan LDL-C dengan persamaan Friedewald, persamaan Hopkins dan homogeneous enzymatic colorimetric assay yang dibagi 3 kelompok berdasarkan kadar trigliserida (TG). Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Uji statistik Spearman didapatkan korelasi mendekati sempurna antara  LDL-C menggunakan persamaan Friedewald dan Hopkins terhadap pemeriksaan direct dengan nilai r=0,921 dan r=0,907. Limit of agreement dari uji Bland-Altman menunjukkan rata-rata > 90% untuk kedua persamaan dengan pengukuran direct. Uji Mann-Whitney menunjukkan perbedaan bermakna antara LDL-C pengukuran direct dengan persamaan Friedewald pada Kelompok Total, TG 200-400 mg/dL dan TG >400 mg/dL sedangkan untuk persamaan Hopkins perbedaan hasil yang bermakna hanya pada kelompok TG >400 mg/dL (p<0,05). Berdasarkan analisis Total Allowable Error (TAE), LDL-C persamaan Hopkins pada kelompok TG 200-400 mg/dL lebih unggul dari persamaan Friedewald.

Kesimpulan: Persamaan Friedewald dan persamaan Hopkins memberikan kesesuaian yang baik pada kadar TG <200 mg/dL sedangkan pada kadar trigliserida 200-400 mg/dL, persamaan Hopkins memberikan kesesuaian yang lebih baik daripada persamaan Friedewald. Pada kadar TG >400mg/dL persamaan Friedewald dan Hopkins menunjukkan akurasi yang rendah sehingga disarankan untuk menggunakan metode direct.

Hubungan diabetes mellitus dengan obstructive sleep apnea (OSA) di Gedung Mario Tabanan, Bali-Indonesia

Background: Diabetes mellitus (DM) is a chronic case caused by the pancreas not being able to produce insulin and when there is insulin resistance. This disease is characterized by a lot of drinking, eating, weight loss and frequent urination. This drastic weight loss results in a decrease in body mass, one of which is the nasopharynx and oropharynx so that it can cause collapse and cause Obstructive sleep apnea (OSA). This study aims to determine whether there is a relationship between diabetes mellitus and OSA in the social service held at the Mario Tabanan building on June 16, 2008.

Methods: An observational analytic study with cross sectional design with a sample of 110 people. This study was conducted at Mario Building, Tabanan, Bali, Indonesia.

Results: A total of 110 samples were successfully collected in this study, with an age range of 50-70 years, 55 patients with diabetes mellitus (DM) and 55 patients without diabetes. From the research above, it was found that there were more men than women, namely 67 people (58.3%) and women amounting to 43 people (42.7%). The average age who received OSA was 57.35 ± 10.89. The results of the study of the prevalence of patient respondents who suffered from DM with OSA were 65 people (53.5%) and patients who did not suffer from DM were 45 (46.5) and patients who did not have DM with OSA were 46 people (47.8%), and those who did not have diabetes and no OSA were 64 people (52.2%). There was a significant relationship between OSA and DM with a p value <0.05 and the prevalence ratio value was the Prevalent Ratio (RP) 1.432 with a confidence interval (1.024 to 5.980).

Conclusion: Diabetes is a risk factor for OSA, and there is a significant relationship between diabetes and the incidence of OSA.

Latar Belakang: Diabetes mellitus (DM) merupakan kasus kronis yang diakibatkan pankreas tidak mampu memproduksi insulin dan ketika ada resistensi insulin. Penyakit ini ditandai dengan banyak minum, makan, berat badan turun drastis dan sering buang air kecil. Penurunan berat badan drastis ini mengakibatkan penurunan massa otot tubuh salah satunya adalah nasofaring dan orofaring sehingga dapat menyebabkan kolaps dan menimbulkan terjadinya Obstructive sleep apnea (OSA). Penelitian ini bertujuan mengetahui apakah ada hubungan antara diabetes mellitus dan OSA pada baksos yang diadakan di gedung Mario Tabanan pada tanggal 16 Juni 2008.

Metode: Penelitian analitik observasional dengan rancangan cross sectional dengan sampel sebanyak 110 orang yang dilakukan di Gedung Mario Tabanan, Bali, Indonesia.

Hasil: Total 110 sampel berhasil dikumpulkan dalam penelitian ini, dengan rentangan usia 50-70 tahun, 55 pasien dengan diabetes mellitus (DM) dan 55 pasien tidak DM. Dari penelitian diatas didapatkan laki-laki lebih banyak daripada perempuan yaitu 67 orang (58,3%) dan perempuan berjumlah 43 orang (42,7%). Rata rata umur yang mendapatkan  OSA 57,35± 10,89. Hasil penelitian prevalensi responden pasien yang menderita DM dengan OSA adalah 65 orang (53,5%) dan, pasien yang tidak menderita DM adalah sejumlah 45 (46,5) dan pasien yang tidak DM dengan OSA adalah sejumlah 46 orang (47,8%) dan yang tidak DM dan tidak OSA adalah 64 orang (52,2%) Didapatkan adanya hubungan signifikan antara OSA dengan DM dengan nilai p<0,05 dan nilai rasio prevalens adalah Rasio Prevalen (RP) 1,432 dengan interval kepercayaan (1,024 sampai 5,980).

Simpulan: Diabetes merupakan faktor risiko dari terjadinya OSA, dan didapatkan hubungan yang bermakna antara diabetes terhadap kejadian OSA.

Brittle bone brothers: osteogenesis imperfecta conventional serial case

Background: Osteogenesis Imperfecta (OI) is a heredity connective tissue disorder due to COL1A1/2 gene mutation, causing a defect in encoding proteins to metabolize collagen. One of OI’s manifestations to musculoskeletal is bone incompetence, hence the name Brittle bone disease. We report three cases of OI type IV in adults with pathognomonic radiology findings.

Case Presentation: In Case 1, a 40-year-old Indonesian male came to the hospital with small stature and unsuited with his age. Conventional radiology examination found OI on all four extremities, anterior dislocation of left shoulder, and old fracture with an acute angle in the left radial shaft. In Case 2, a 41-year-old Indonesian male came to the hospital with short stature, causing limitation to his activities, and he confessed always to be shorter than people his age. Radiology evaluation suggests an OI in bilateral superior and inferior extremities, old fractures in the right humeral shaft also the left clavicle, acute angles right radius-ulna shaft, and osteoporosis in all visualized bones. In addition, in Case 3, a 42-year-old Indonesian male came to the hospital with short stature and pain within his bones, causing limitation to his activity. Conventional radiology imaging shows bilateral superior and inferior extremities, old fracture in the medial third of the left humerus and bilateral femur, acute-angled bilateral antebrachial-femur-cruris, and osteoporosis

Conclusion: Based on OI categorization, only type I and IV can live to adulthood, and the same type of OI can be found in siblings. Conventional radiology imaging provides a great help in diagnosing OI.

Prevalensi kejadian perdarahan uterus abnormal di Rumah Sakit Umum Daerah Wangaya Denpasar periode Januari – Desember 2020

Introduction: Abnormal uterine bleeding (AUB) is the most common gynecological disorder experienced by women of reproductive age. The Federation of Gynecology and Obstetrics (FIGO) classifies AUB according to its etiology into PALM-COEIN. This study aims to determine the prevalence of AUB incidence according to the FIGO classification and AUB patients' characteristics based on age group, parity, BMI, and educational level at Wangaya Hospital Denpasar.

Method: The study design is descriptive retrospective. Samples were collected by total sampling. Data was taken from medical records of patients diagnosed with AUB in Obstetrics-Gynaecology Polyclinic and Obstetrics-Neonatal Comprehensive Emergency Services at Wangaya Hospital Denpasar period January-December 2020.

Result: The results showed 68 cases of AUB (15.8%) from 437 gynecologic cases. AUB due to structural abnormalities is 45 people (66.2%) with the most cases being AUB-L are 26 people (38.2%). In comparison, AUB was not due to structural abnormalities are 23 people (33.8%) with the most cases AUB-O, namely 18 people (26.4%). The AUB incidence most occurred in the age group ?41 years which is 25 people (36.8%). Parity ?2 times had the most AUB incidence, namely 26 people (57.8%). The most AUB incidence in normal BMI (18.5-24.9), namely 53 people (77.8%), and 37 people (54.4%) at the nongraduated.

Conclusion: Prevalence of AUB incidents at Wangaya Hospital Denpasar period January-December 2020 almost one-fifth of all gynecological cases. The AUB incidence most prevalent in the age group ?41 years, parity ? 2 times, normal BMI, and non-graduated.

Latar Belakang: Perdarahan uterus abnormal (PUA) merupakan kelainan di bidang ginekologi yang paling sering dialami oleh perempuan usia produktif. Federation of Gynecology and Obstetrics (FIGO) mengklasifikasikan PUA menurut etiologinya menjadi PALM-COEIN. Penelitian ini bertujuan untuk mengetahui prevalensi kejadian PUA sesuai klasifikasi FIGO dan mengetahui karakteristik pasien PUA berdasarkan kelompok usia, paritas, IMT, dan tingkat pendidikan di RSUD Wangaya Denpasar.

Metode: Rancangan penelitian yang digunakan adalah deskriptif retrospektif. Teknik penentuan sampel yang digunakan adalah total sampling. Data penelitian didapatkan dari rekam medis pasien di Poliklinik Kebidanan-Kandungan dan Pelayanan Obstetri Neonatal Emergensi Komprehensif (PONEK) Rumah Sakit Umum Daerah (RSUD) Wangaya Denpasar periode Januari – Desember 2020.

Hasil: Dari hasil penelitian didapatkan 68 kasus PUA (15,8%) dari 437 kasus di ginekologi. PUA karena kelainan struktural sebanyak 45 orang (66,2%) dengan kasus terbanyak adalah PUA-L 26 orang (38,2%), sedangkan PUA bukan karena kelainan struktural sebanyak 23 orang (33.8%) dengan kasus terbanyak PUA-O yaitu 18 orang (26,4%). Kejadian PUA paling banyak terjadi pada kelompok usia ?41 tahun sebanyak 25 orang (36,8%). Paritas ?2 kali paling banyak mengalami kejadian PUA yaitu 26 orang (57,8%). Kejadian PUA paling banyak pada IMT Normal (18,5-24,9) yaitu 53 orang (77,8%), dan tingkat pendidikan bukan Sarjana/D3 sebanyak 37 orang (54,4%).

Simpulan: Prevalensi Kejadian PUA di RSUD Wangaya Denpasar periode Januari – Desember 2020 hampir seperlima dari seluruh kasus ginekologi. Kejadian PUA paling banyak terjadi pada kelompok usia ?41 tahun, paritas ?2 kali, IMT normal, dan tingkat pendidikan bukan Sarjana/D3.

Tatalaksana bedah pada eksotropia traumatika et causa ruptur total otot rectus medial: laporan kasus

Introduction: Traumatic strabismus may result because of closed or open head and/or orbital trauma. Trauma to the extraocular muscles will often result directly in specific ocular motility disorders. Vertical transposition is one of the surgical management in traumatic exotropia with medial rectus muscle total rupture. The aims of case report are to know about examination and management in patient with traumatic exotropia.

Case Illustration: Male, 30 years old, came with chief complaints pain on the right eye after being exposed a wire bounce when take off a banner wire, with squint eye, blurry vision, diplopia, redness, bleeding. On ophthalmology examination, 45° exotropia, visual acuity on the right eye 6/18 ph NI, proptosis, edema, hematom, spasm palpebral. Medial rectus muscle rupture, full thickness conjunctival rupture, cresent shaped, 15x7mm, 3 mm from limbal. Eyeball movement limited to medial, superomedial, inferomedial, FGT medial parese right eye (RE). visual acuity on the left eye 6/6, anterior and posterior segment within normal limit. Patient was diagnosed with traumatica exotropia et causa medial rectus muscle total rupture right eye (RE) with complication axial proptosis ec retrobulbar hemorrhage, palpebral hematom, full thickness conjunctival ruptured, sub conjunctival bleeding, erosion cornea, iridoplegy, traumatic iritis. Vertical transposition with augmented Hummelsheim technique, cantotomy cantolysis, repair conjunctival ruptured was done to the patient.

Conclusion: Vertical transposition is one of the surgical management in traumatic exotropia caused by medial rectus muscle total rupture 

Pendahuluan: Eksotropia traumatik dapat disebabkan oleh adanya trauma terbuka/tertutup pada kepala/mata. Trauma pada otot ekstraokuler akan menyebabkan gangguan gerakan bola mata yang spesifik. Salah satu penanganan bedah pada eksotropia traumatik karena ruptur total otot rektus medial adalah dengan transposisi vertikal. Tujuan dari pembuatan laporan kasus in adalah untuk mengetahui pemeriksaan dan penanganan pasien dengan eksotropia traumatika.

Laporan kasus: Pria dengan usia 30 tahun, datang dengan keluhan nyeri pada mata kanan setelah terkena pentalan kawat, disertai mata juling keluar, pandangan ganda, kabur, berdarah, mata merah. Pada pemeriksaan oftalmologi didapatkan eksotropia 45°, tajam penglihatan mata kanan 6/18 ph NI, dengan proptosis, edema, hematom, spasme pada palpebra. Pada konjungtiva didapatkan tampak ruptur rektus medialis, ruptur konjungtiva full thickness bentuk bulan sabit ukuran 15x7mm, 3 mm dari limbus. Gerakan bola mata terhambat ke medial, superomedial, inferomedial, Forced Generation Test (FGT) mata kanan paresis ke medial. Tajam  penglihatan mata kiri 6/6, segmen anterior dan posterior dalam batas normal. Pasien didiagnosis dengan eksotropia traumatika et causa ruptur total otot rektus medial oculi dextra (OD) dengan komplikasi proptosis axial ec suspek pendarahan retrobulbar, hematom palpebral, ruptur konjungtiva full thickness, pendarahan sub konjungtiva, erosi kornea, iridoplegia, traumatic iritis. Pada pasien ini dilakukan transposisi vertikal dengan teknik augmented Hummelsheim, kantotomi kantolisis, dan repair ruptur konjungtiva full thickness.

Simpulan: Transposisi otot rektus vertikal merupakan salah satu tindakan untuk tatalaksana pembedahan pada eksotropia traumatika et causa ruptur total otot rektus medial

Prevalensi obesitas pada pasien kanker kolorektal di RSUP Sanglah periode 2019 - 2020

Background: Colorectal cancer is cancer that develops slowly and begins as a tumor or growth of tissue from the inner surface of the rectum or colon. Colorectal cancer can be influenced by exogenous factors that can be modified, one of which is obesity. This study aims to determine the prevalence of obesity in colorectal cancer patients.

Methods: This research was a descriptive study with a retrospective approach using medical record data and the sampling technique was total sampling. The data obtained according to the inclusion and exclusion criteria were 100 data which were then analyzed using SPSS version 20 for Windows. Data was taken from the 100 medical records for age, sex, Body Mass Index (BMI), and histopathology of colorectal cancer. The data was obtained from the Installation Medical Record at Sanglah Hospital.

Results: The results found a difference in colorectal cancer patients with BMI ?25 and <25 kg/m². Patients with a BMI <25 kg/m² were 90 patients (90.00%) more suffering from colorectal cancer than 10 patients (10.00%) who had a BMI ?25 kg/m². Based on age, the most colorectal cancer was found at ? 56 years old, namely 52.0%. In contrast, based on the type of cancer, there were more adenocarcinoma types, namely 88 patients (88.0%) compared to histopathological types of cancer that were difficult to find (12.00%).

Conclusion: From the results of this study, it can be concluded that colorectal cancer patients attack more than or equal to 56 and BMI <25 kg/m².

Latar Belakang: Kanker kolorektal merupakan kanker yang berkembang dengan lambat dan berawal sebagai tumor atau perkembangan jaringan dari permukaan dalam rektum atau kolon. Kanker kolorektal dapat dipengaruhi oleh faktor eksogen yang dapat dimodifikasi salah satunya adalah obesitas. Penelitian ini bertujuan untuk mengetahui prevalensi obesitas pada pasien kanker kolorektal.

Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan retrospektif menggunakan data rekam medis dan teknik pengambilan sampel adalah total sampling. Data yang diperoleh sesuai dengan kriteria inklusi dan eksklusi sebanyak 100 data yang kemudian dianalisis menggunakan SPSS versi 20 untuk Windows. Dari 100 rekam medis diambil data umur, jenis kelamin, IMT dan histopatologi kanker kolorektal. Data diperoleh dari Instalasi Rekam Medis RSUP Sanglah.

Hasil: Pada hasil ditemukan adanya perbedaan pada pasien kanker kolorektal dengan IMT?25 dengan <25 kg/m². Pasien dengan IMT<25 kg/m² yaitu sebanyak 90 pasien (90,0%) lebih banyak menderita kanker kolorektal dibandingkan dengan 10 pasien (10,0%) yang memiliki IMT ?25 kg/m². Dilihat dari usia pasien, didapatkan kanker kolorektal paling banyak pada usia ? 56 tahun yaitu 52,0%, sedangkan pada jenis kanker didapatkan tipe adenokarsinoma lebih banyak yaitu 88 pasien (88,0%) dibandingkan tipe histopatologi kanker yang sulit dijelaskan (12,0%).

Kesimpulan: Dari hasil penelitian ini dapat disimpulkan bahwa pasien kanker kolorektal lebih banyak menyerang pada usia lebih dari atau sama dengan 56 dan IMT <25 kg/m².

Gonadotropin Releasing Hormone Agonis (GNRH-A) vs Human Chorionic Gonadotropin (hCG) vs Gonadotropin Releasing Hormone Agonis (GNRH-A) + Human Chorionic Gonadotropin (HCG) sebagai stimulan pematangan oosit, tingkat pembuahan, kualitas embrio, tingkat keha

Background: The stimulation of Human Chorionic Gonadotropin (hCG) vs. Gonadotropin-Releasing Hormone (GnRH) agonists vs. hCG + GnRH agonists plays an important role in influencing oocyte maturation, fertilization, embryo quality, pregnancy, live birth rates, and Ovarian Hyperstimulation Syndrome (OHSS) during IVF. This study aims to determine the effectiveness of hCG vs. GnRH agonist stimulation vs. hCG + GnRH agonists regarding oocyte maturation levels, embryo quality, fertilization, pregnancy, live birth rates, and OHSS while undergoing IVF program.

Methods: This cross-sectional analytic study was conducted on 86 samples, including 33 hCG group, 12 GnRH agonist group, and 41 hCG + GnRH agonist group. The secondary data was obtained from the IVF clinical laboratory results at Puri Bunda Hospital and BROS hospital. Data were analyzed using SPSS version 20 for Windows.

Results: There were no significant differences in age, duration of infertility, levels of Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol, duration of stimulation, level of oocyte maturation, fertilization, embryo quality, pregnancy, live birth rate and OHSS ( p> 0.05) in each group. However, there was a significant difference in the Body Mass Index (BMI) (p = 0.032) and the number of oocytes (p = 0.020) in each group.

Conclusion: There were no significant differences in oocyte maturation, fertilization rates, embryo quality, pregnancy, live birth rates, and OHSS. 

Latar Belakang: Stimulasi Human Chorionic Gonadotropin (hCG) vs Gonadotropin Releasing Hormone (GnRH) agonis vs hCG+GnRH agonis berperan penting dalam mempengaruhi pematangan oosit, pembuahan, kualitas embrio, kehamilan, tingkat kelahiran hidup, dan Ovarian Hiperstimulation Syndrome (OHSS) pada saat menjalani program bayi tabung. Penelitian ini bertujuan untuk mengetahui efektifitas dari stimulasi hCG vs GnRH agonis vs hCG+GnRH agonis mengenai tingkat pematangan oosit, kualitas embrio, pembuahan, kehamilan, kelahiran dan OHSS saat menjalani program bayi tabung.

Metode: Penelitian potong lintang analitik ini dilakukan terhadap 86 sampel meliputi 33 kelompok hCG, 12 kelompok GnRH agonis, dan 41 kelompok hCG+GnRH agonis. Data sekunder diperoleh dari hasil laboratorium klinik IVF Rumah Sakit Puri Bunda dan rumah sakit BROS. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Tidak terdapat perbedaan bermakna pada usia, durasi infertilitas, kadar Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol, durasi stimulasi, tingkat pematangan oosit, pembuahan, kualitas embrio, kehamilan, tingkat kelahiran hidup dan OHSS (p>0,05) pada masing-masing kelompok. Namun, terdapat perbedaan bermakna pada Indeks Massa Tubuh (IMT) (p=0,032) dan jumlah oosit (p=0,020) pada masing-masing kelompok.

Kesimpulan: Tidak ditemukannya perbedaan yang bermakna pada tingkat pematangan oosit, pembuahan, kualitas embrio, kehamilan, tingkat kelahiran hidup dan OHSS.

Hubungan antara ekspresi Vascular Endothelial Growth Factor (VEGF) dengan karakteristik klinikopatologi osteosarkoma di RSUP Sanglah Denpasar, Bali

Background: Osteosarcoma is the most common malignant primary bone tumor. Although osteosarcoma cases are relatively rare compare to carcinoma, the mortality rate is quite high. Osteosarcoma prognosis can be seen from conventional pathology and biological markers, such as Vascular Endothelial Growth Factor (VEGF). In various studies, the presence of VEGF expression has been associated with the worsening prognosis of osteosarcoma. This study aims to determine the relationship between VEGF expression and osteosarcoma's clinicopathological characteristics at Sanglah General Hospital, Denpasar, 2015-2019.

Method: This research is a cross-sectional analytic study. The sampling technique used all affordable populations that were included in the inclusion criteria, with a total sample of 30 samples. The research data used secondary data obtained from the archive of histopathological examination reports at the Anatomical Pathology Laboratory at Sanglah General Hospital and paraffin blocks from all available samples for immunohistochemical examination. Data were analyzed using SPSS version 22 for Windows.

Results: The clinicopathological characteristics of the osteosarcoma studied were age, tumor location, histological type, and grading. Patients with osteosarcoma in this study were predominantly found in the age group <20 years (66.67%), femur locations (60.00%), mixed type osteosarcoma (53.33%), and high grade (100.00%). A total of 26 samples (86.67%) had high VEGF expression and 4 samples had low VEGF expression (13.30%). There was no significant relationship between age (p=0.241), location of the tumor (p=0.739), and histological type (p=1.000) to the VEGF expression.

Conclusion: The relation between each osteosarcoma clinicopathological characteristic associated with VEGF expression showed insignificant results in age, location, and histological type. Further research is needed with a more significant number of samples to get better results.

Latar Belakang: Osteosarkoma adalah tumor tulang primer ganas yang paling umum. Meskipun kasus osteosarkoma relatif jarang dibandingkan dengan karsinoma, angka kematiannya cukup tinggi. Prognosis osteosarkoma dapat dilihat dari patologi konvensional dan penanda biologis, salah satunya adalah Vascular Endothelial Growth Factor (VEGF). Dalam berbagai penelitian, kehadiran ekspresi VEGF telah dikaitkan dengan prognosis yang memburuk dari osteosarcoma. Penelitian ini bertujuan untuk mengetahui hubungan ekspresi VEGF dengan karakteristik klinikopatologi osteosarkoma di RSUP Sanglah Denpasar tahun 2015-2019.

Metode: Penelitian ini merupakan penelitian analitik potong lintang. Teknik pengambilan sampel menggunakan semua populasi terjangkau yang termasuk dalam kriteria inklusi, dengan jumlah sampel sebanyak 30 sampel. Data penelitian menggunakan data sekunder yang diperoleh dari arsip laporan pemeriksaan histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah dan blok parafin dari semua sampel yang tersedia untuk pemeriksaan imunohistokimia. Data dianalisis dengan SPSS versi 22 untuk Windows.

Hasil: Karakteristik klinikopatologi dari osteosarkoma yang diteliti adalah usia, lokasi tumor, tipe histologis, dan grading. Penderita osteosarkoma pada penelitian ini paling banyak ditemukan pada kelompok usia <20 tahun (66,67%), lokasi femur (60%), tipe campuran osteosarkoma (53,33%) dan High-Grade (100.00%). Sebanyak 26 sampel (86,67%) memiliki ekspresi VEGF tinggi dan 4 sampel memiliki ekspresi VEGF rendah (13,30%). Tidak terdapat hubungan yang bermakna antara usia (p=0,241), lokasi (p=0,739), dan tipe histologis (p=1,000).

Kesimpulan: Hubungan antara masing-masing karakteristik klinikopatologi osteosarkoma yang terkait dengan ekspresi VEGF menunjukkan hasil yang tidak bermakna pada usia, lokasi, dan tipe histologis. Diperlukan penelitian lebih lanjut dengan jumlah sampel yang lebih banyak untuk mendapatkan hasil yang lebih baik.

Correlation of glutamine and serial absolute neutrophil count as a parameter of infection in major burn trauma patients at Sanglah General Hospital, Bali, Indonesia

Background: Burns are thermal trauma that often results in high morbidity. In major burns, gastrointestinal dysfunction plays a vital role in the progression of infection to organ failure. Glutamine is a pharmaconutrient that has important implications for burn patients, including in the prevention of infection. This study evaluates the relationship between glutamine administration and the serial absolute neutrophil count as a parameter for infection incidence in patients with major burns.

Methods: This study was an analytical study with a cross-sectional design to see the relationship between glutamine administration and the serial absolute neutrophil count levels of major burn patients at Sanglah General Hospital. The sample consisted of 56 patients from the medical records of burn patients. The data were extracted from the medical records and then inserted into the data collection sheet. Then performed data analysis using SPSS version 21 for Windows.

Results: Bivariate analysis showed that there was a significant difference between glutamine administration and the absolute neutrophil count levels on days 3, 5, and 14 (p = 0.004, 95% CI: 1.70-8.46), (p = 0.000, 95% CI: 2.71-7.83), and (p = 0.035, 95% CI: 0.61-7.27), respectively. This showed that patients given glutamine had lower neutrophil levels on days 3, 5, and 14 than patients who were not given glutamine. Multivariate analysis confirmed that glutamine administration did independently affect and decrease the absolute neutrophil count levels on days 3, 5, 14, and the mean without being influenced by other variables with p value = 0.004 (95% CI: [-8.445] - [-1,732]), p = 0.000 (95% CI: [-7,808]-[-2,743]), p = 0.020 (95% CI: [-7.251]-[-0.639]), and p = 0.017 (95% CI: [-5,815]-[-0.588]), respectively.

Conclusion: This study has shown that glutamine administration was significantly associated with and decreased the serial absolute neutrophil count in major burn patients.

Faktor-faktor klinikopatologi kekambuhan kanker serviks stadium I-IIA2 pasca histerektomi radikal di RSUP Sanglah periode 2019–2020

Background: Cervical cancer is the second-largest malignant disease in Indonesia. Recurrence in early-stage cervical cancer is high. However, data of clinicopathological factors for recurrence of early stage cervical cancer in Indonesia, especially in Denpasar, are still challenging to find. Thus, this study aims to determine the clinicopathological factors for recurrence cervical stage I-IIA2 post radical hysterectomy at Sanglah General Hospital.

Methods: This research is an analytical cross sectional study using medical record data and the sampling technique is total sampling. According to the inclusion and exclusion criteria, the data obtained were 46 data, which were then analyzed using SPSS version 25 for Windows.

Results: The bivariate analysis of this study showed that the variables age, histopathology, incision margin, and parametrial involvement were not significantly associated with the recurrence rate (p> 0.05). The factors significantly associated with the recurrence rate were a clinical stage, tumor size, and positive lymph nodes (p <0.05).

Conclusion: Clinical stage, tumor size, and lymph node metastases are three independent factors for cervical cancer recurrence after radical hysterectomy surgery.

Keywords: Cervical Cancer, Recurrence, Radical Hysterectomy, Sanglah General Hospital Denpasar.

Latar belakang:  Kanker serviks adalah penyakit keganasan kedua terbanyak di Indonesia. Kekambuhan pada kanker serviks stadium awal tergolong tinggi. Namun, data mengenai faktor-faktor kekambuhan kanker serviks stadium awal di Indonesia khususnya di Denpasar masih sulit ditemukan. Sehingga, penelitian ini bertujuan untuk mengetahui faktor-faktor kekambuhan kanker serviks stadium I-IIA2 pasca histerektomi radikal di RSUP Sanglah Denpasar.

Metode: penelitian ini merupakan penelitian analitik potong lintang dengan menggunakan data rekam medis dan teknik penentuan sampel adalah Total Sampling.  Data yang didapat sesuai kriteria inklusi dan eksklusi adalah 46 data yang kemudian doiolah dengan SPSS versi 25 untuk Windows.

Hasil: Analisis bivariat penelitian ini menunjukan bahwa variabel usia, histopatologi, batas sayatan, dan keterlibatan parametrium tidak berhubungan secara bermakna dengan tingkat kekambuhan (p>0,05). Faktor-faktor yang berhubungan secara bermakna dengan tingkat kekambuhan adalah stadium klinis, ukuran tumor, dan kelenjar limfe positif (p<0,05).

Kesimpulan: Stadium klinis, ukuran tumor, dan metastasis pada kelenjar limfe adalah tiga faktor independen untuk kekambuhan kanker serviks setelah operasi radikal histerektomi.

The use of compression stockings produces lower Interleukin-6 (IL-6) levels, Higher American Orthopaedic Foot and Ankle Society Score (AOFAS), and does not produce higher alkaline phosphatase level in postoperative patients with fracture around the ankle

Background: Fractures around the ankles are common injuries. The use of compression stockings is one of the postoperative modalities that has been widely used in developing countries but is rarely used in Indonesia. This study aimed to determine the effect of using compression stockings on changes in inflammatory biomarkers level and functional outcomes in postoperative patients with fractures around the ankle.

Methods: This study was a randomized clinical trial (post-operative-only design) in 26 patients with fractures around the ankle. The study subjects were divided into groups using postoperative compression stockings and groups without compression stockings. Its efficacy was assessed by measuring levels of Interleukin-6 (IL-6), Alkaline Phosphatase (ALP), and American Orthopedic Foot and Ankle Society (AOFAS) scores. Data were analyzed using SPSS version 20 for Windows.

Results: Postoperative 24-hour IL-6 levels were not significantly different (p=0.200; -59.93–266.42), but they were significantly different postoperatively in 3 days (p = 0.001; 8.76-30.21), 14 days (p=0.015; 2.40-20.49), and 30 days (p=0.000; -15.49–[-5.03]). ALP was not different significantly, both at 24 hours (p=0.160; -16.0-2.80), 3 days (p=0.072; -0.65-14.19), 14 days (p=0.098; -1,310–12,54), and 30 days (p=0.419; -5.00–11.61) after surgery. The AOFAS scores was different significantly 30 days postoperatively (p=0.000; -3.915– [-1.469]).

Conclusion: The use of compression stockings can be considered as postoperative therapy to lower the IL-6 levels but do not affect ALP levels in postoperative patients with fractures around the ankle. The use of compression stocking resulted in a higher AOFAS score than without wearing compression stockings in postoperative patients with fractures around the ankle.

Epidemiologi pasien luka bakar di RSUP Sanglah Denpasar tahun 2018-2019

Background: Burns are loss of tissue or a form of tissue damage that occurs as a result of contact with heat sources such as fire, chemicals, hot water, electricity, and radiation which are a type of trauma with high morbidity and mortality so that they require special treatment from the initial phase to advanced phase. This study aims to find out, comprehend, and describe the epidemiology of burn patients' causes and mortality at the Sanglah General Hospital in 2018-2019.

Methods: The research was conducted with a descriptive method using cross-sectional studies. Samples were selected from the population-based on inclusion and exclusion criteria. Data were analyzed using SPSS version 24 software to obtain the epidemiology of the causes, length of stay, and burns mortality.

Results: The results showed that the highest cause of burns was caused by fire, namely 65 people (53.3%). In the adult group, most burns were caused by fire, namely 55 people (45.1%), while in the group of children, most burns were caused by objects / hot water, namely 14 people (11.5%). The mortality of burnt sufferers was 11 people (9%) out of 122 people (100%), where all deaths occurred in the adult group. An IIAB degree burns were the highest burns with the highest mortality with 10 people (90.9%). Most of the burn injuries caused by fire burns were 7 people (63.6%) and the highest case was second-degree burns caused by fire, namely 60 people (56.1%).

Conclusion: The results showed that the most common burns were caused by a fire in the adult group and objects/hot water in the children group. IIAB degree burns are the highest degree of burns with mortality.

Latar Belakang: Luka bakar adalah kehilangan jaringan atau suatu bentuk kerusakan jaringan yang terjadi akibat dari kontak dengan sumber panas seperti api, bahan kimia, air panas, listrik dan radiasi yang merupakan jenis trauma dengan morbiditas dan mortalitas yang tinggi sehingga memerlukan perawatan yang khusus mulai fase awal hingga fase lanjut. Penelitian ini bertujuan untuk mengetahui, memahami dan mendeskripsikan epidemiologi penyebab dan mortalitas pasien luka bakar di Rumah Sakit Umum Pusat Sanglah Denpasar tahun 2018-2019.

Metode: Penelitian dilakukan dengan metode deskriptif menggunakan studi potong lintang. Sampel dipilih dari populasi berdasarkan kriteria inklusi dan eksklusi. Data dianalisis menggunakan software SPSS versi 24 untuk mendapatkan epidemiologi penyebab dan mortalitas luka bakar.

Hasil: Hasil penelitian menunjukkan bahwa epidemiologi penyebab luka bakar tertinggi disebabkan oleh api yaitu 65 orang (53,3%).  Pada kelompok dewasa, pasien luka bakar terbanyak disebabkan oleh api yaitu 55 orang (45,1%), sedangkan pada kelompok anak-anak luka bakar terbanyak disebabkan oleh benda/air panas yaitu 14 orang (11,5%). Mortalitas pasien luka bakar yaitu 11 orang (9%) dari 122 orang (100%), dimana semua kematian terjadi pada kelompok dewasa. Luka bakar derajat IIAB merupakan derajat luka bakar dengan kematian tertinggi yaitu 10 orang (90,9%). Kematian luka bakar terbanyak disebabkan oleh luka bakar akibat api sebanya 7 orang (63,6%) dan kasus tertinggi adalah luka bakar derajat IIAB yang disebabkan oleh api yaitu 60 orang (56,1 %).

Kesimpulan: Hasil penelitian ini menunjukkan bahwa luka bakar tersering disebabkan oleh api pada kelompok dewasa dan benda/air panas pada kelompok anak-anak. Luka bakar derajat IIAB merupakan derajat luka bakar dengan kematian tertinggi.

Hubungan andropause dengan skor IPSS pada pegawai di institusi pusat pemerintahan Kabupaten Badung-Bali

Background: Andropause is a term which indicate reduced male testosterone levels. The mechanism of andropause is due to decreased male reproductive function which results in decreased levels of testosterone in the blood below normal levels. On the other hand, almost 50% of men aged 45-60 years experience complaints of urination due to Benign Prostate Hyperplasia (BPH). Until now, BPH is believed to be related to the aging process and decreased levels of the hormone testosterone or andropause. However, no clear evidence indicate a relathionship between andropause and severe micturition probelm. This study aims to determine the relathionship of andropause and the IPSS score.

Methods: This study is an analytic observational study with a cross sectional method. Sampling in this study using purposive sampling with respondent taken from the Central Government Institution of Badung Regency, Bali. The total number of research respondents was 40 man. Symptoms and signs of andropause were evaluated using the Androgen Deficiency in the Aging Male (ADAM) questionnaire, while the degree of symptoms of micturition was determined by the International Prostate Symptom Score (IPSS). The data was analyze descriptively and analytically with Chi-square to determine the relationship between andropause status and the degree of micturition problem.

Results: Complaints of moderate micturition problem were the most common complaint in andropause respondents (45.5%) while mild complaints were the most common among respondents who did not experience andropause (72.2%). The results showed a significant relationship between respondents who experienced andropause and the tendency to complain of symptoms of obstruction due to prostate enlargement as assessed by the IPSS score (p = 0.038).

Conclusion: There is a significant relationship between respondents experiencing andropause and the tendency to complain of symptoms of obstruction due to prostate enlargement.

Pendahuluan: Andropause merupakan suatu istilah yang berarti menurunnya kadar hormon testosteron pada laki-laki. Mekanisme terjadinya andropause adalah karena menurunnya fungsi reproduksi laki-laki yang berakibat menurunnya kadar testosteron dalam darah dibawah angka normal. Disisi lain, laki-laki usia 45-60 tahun hampir 50% mengalami keluhan miksi akibat Benign Prostate Hyperplasia (BPH). BPH hingga saat ini diyakini berhubungan dengan proses penuaan dan penuruan kadar hormon testosteron atau andropause. Akan tetapi belum banyak bukti menunjukan hubungan andropause dengan beratnya gangguan miksi akibat BPH. Penelitian ini bertujuan untuk mengetahui hubungan status andropause dengan skor IPSS.

Metode: Penelitian ini merupakan penelitian observasional analitik dengan metode potong lintang. Pengambilan sampel pada penelitian ini menggunakan purposive sampling dengan responden diambil dari Institusi Pusat Pemerintah Kabupaten Badung, Bali. Keseluruhan responden penelitian berjumlah 40 orang. Gejala dan tanda andropause dievaluasi dengan kuisioner Androgen Deficiency in the Aging Male (ADAM) sedangkan derajat gejala gangguan miksi ditetukan dengan skor International Prostate Symptom Score (IPSS). Analisis data berupa deskriptif serta analitik dengan Chi-square untuk menentukan hubungan status andropause dengan derajat gangguan miksi.

Hasil: Keluhan gangguan miksi derajat sedang merupakan tingkat keluhan paling umum pada responden andropause (45,5%) sedangkan keluhan ringan merupakan keluhan paling umum pada responden tidak mengalami andropause (72,2%). Hasil penelitian menunjukkan hubungan yang signifikan antara responden yang mengalami andropause dan kecenderungan mengeluhkan gejala obstruksi akibat pembesaran prostat yang dinilai melalui Skor IPSS (p=0,038).

Simpulan: Terdapat hubungan yang signifikan antara responden yang mengalami andropause dan kecenderungan mengeluhkan gejala obstruksi akibat pembesaran prostat.

Pengaruh pemberian edukasi kepada pengasuh terhadap tingkat kepatuhan pemberian obat anti epilepsi pada anak dengan epilepsi

Background: Adherence was the main problem in anti-epilepsy drug therapy because it has to be consumed up to 2 years free of seizures to require education intervention. This research aimed to analyze the effect of oral and written (leaflet) education on patient carer's adherence level in administering epilepsy medicines to the pediatric patient (?18 years old).

Methods: The design of This study was one group pre - post-test research. Subjects were collected using consecutive sampling.

Results: This study's subject was 24 patient carers with low and moderate levels of medication adherence. Oral and written education material was provided every week for eight weeks, and the adherence level was analyzed through the pills count and self-report checklist every week during the study. The Wilcoxon signed-rank test results were significantly different between pre and post-pill counts, and the result of repeated measure test showed that there was an increasing level of medication adherence significantly in third obtained by pill count method week ( p=0,000 ) and remained high until the end of this study.

Conclusion: Oral and written education could improve the caregivers administering medication adherence level to their epilepsy children.

Latar belakang: Kepatuhan merupakan masalah utama dalam terapi obat anti epilepsi karena obat anti epilepsi harus dikonsumsi sampai 2 tahun bebas kejang, sehingga diperlukan edukasi. Penelitian ini bertujuan untuk menganalisis pengaruh pemberian edukasi berupa lisan dan tertulis (leaflet) terhadap tingkat kepatuhan pemberian obat oleh pengasuh kepada pasien epilepsi anak usia ?18 tahun.

Metode: Rancangan penelitian ini adalah one group pre – post test design. Pengumpulan subjek dengan consecutive sampling.

Hasil: Subjek penelitian sebanyak 24 orang dengan kriteria tingkat kepatuhan rendah dan sedang. Edukasi lisan dan tertulis diberikan setiap minggu selama 8 minggu, penilaian tingkat kepatuhan melalui pill count dan self report checklist setiap minggu selama 8 minggu. Hasil uji wilcoxon signed rank terdapat perbedaan pre pill count dan post pill count, dan hasil uji repeated measure terdapat pengaruh pemberian edukasi, yang dapat dilihat dari peningkatan nilai pill count secara signifikan pada minggu ke-3 (p=0,000) dan tetap tinggi sampai akhir penelitian.

Simpulan: Pemberian edukasi berupa lisan dan tertulis memberikan pengaruh peningkatan kepatuhan pemberian obat oleh pengasuh kepada pasien epilepsi anak.

Clinical characteristics and demographics figures of patients with age-related macular degeneration at a tertiary-level hospital in Denpasar, Bali

Introduction: Age-Related Macular Degeneration (AMD) is a macular disease that characteristically affects the loss of central vision of the elderly. Unlike the western world, Indonesia has a relatively undocumented AMD epidemiology due to a lack of scientific attention, as indicated by few AMD publications. As a result, it is difficult to determine AMD's features and characteristics in the Indonesian population. This study aimed to evaluate AMD patients' characteristics and demographics at a tertiary hospital in Bali.

Methods: This is a Cross-Sectional study. Data were collected from medical records on Sanglah General Hospital from January 2017 until December 2019. The characteristics and features were collected and analyzed. The characteristics and demo-figure were analyzed with descriptive statistics and a Chi-square test.

Results: This study data consist of 172 patients, 90 (52.33 %) male and 82 (47.67 %) female. Most of the patients in the age group 66-83 years. The distribution of dry AMD showed the highest number on males, but the inverse occurs in wet AMD. Subjects had a smoking lifestyle in 50% of the patients. The smoking history more likely in dry AMD, but the inverse occurs in wet AMD. Hypertension occurs in more than half (51.16 %), with larger distribution in wet AMD. The proportion of gender, smoking history, hypertension but not age are significantly different between wet and dry AMD.

Conclusion: Age-related macular degeneration is a common cause of blindness in the elderly population. This study found that the prevalence of AMD increases with age. The significant factors associated with AMD were sex, hypertension and smoking habit.

Karakteristik pasien kebidanan dengan infeksi COVID-19 di Ruang Praja RSUD Wangaya Bali periode Mei - Desember 2020

Background: Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the SARS-COV2 virus. Pregnant women are important because pregnant women are more susceptible to viral infections and severe pneumonia due to physiological changes in the immune and cardiopulmonary systems during pregnancy, with manifestations ranging from asymptomatic to very severe. At this time, no research has been conducted on the local population, so that the authors will examine the characteristics of obstetric patients with COVID-19 infection in the Praja room of RSUD WANGAYA Bali. To determine the characteristics of midwifery patients with COVID-19 infection in the Praja room at Wangaya Bali Hospital for the period May 2020 - December 2020.

Methods: This study was a retrospective descriptive study using medical records from mothers related to COVID-19. The inclusion criteria were obstetric patients with COVID-19 infection in the Praja room with the results of a reactive Rapid Test or RT-PCR at Wangaya Hospital. The data collected were age, parity, screening rapid test, comorbid, probable case, clinical symptoms, laboratory results, chest x-ray, baby weight and APGAR score, type of delivery, amount of postpartum hemorrhage, confirm case with RT-PCR, length of treatment, the need for ICU rooms and the number of deaths.

Results: In this study, there were 67 respondents. Most of them were in the age range of 21-30 years and had given birth more than once. More than half of the respondents had a cesarean section, and most of the respondents tested positive for COVID-19 through the RT-PCR test. APGAR scores and baby weight were mostly normal. There were 62 respondents confirmed as RT-PCR, while with the Rapid reactive results, 66 people. Patients with mild anemia were found and found an increase in the number of CRP and neutrophils. Asymptomatic and non-comorbid patients were the most common, and on the x-ray image, most had pneumonia. There was no postpartum hemorrhage in either method of delivery. Only one person needs an ICU room. Patients infected with COVID-19 require a longer treatment time.

Conclusion: Most were found in no comorbid and asymptomatic. Laboratory results were mostly found with mild anemia, leukocytosis with neutrophilia and high NLR, and high CRP. Most pregnant women do not need ICU care.

Latar belakang: Penyakit corona virus 2019 (COVID-19) merupakan penyakit yang sangat menular yang disebabkan oleh virus SARS-COV2. Wanita hamil penting untuk diperhatikan karena wanita hamil lebih rentan terhadap infeksi virus dan pneumonia parah akibat adanya perubahan fisiologis pada sistem imun dan cardiopulmonal selama kehamilan, dengan manisfestasi dari tanpa gejala hingga sangat berat. Pada saat ini belum ada penelitian yang di lakukan pada populasi lokal, sehingga penulis akan meneliti karakteristik pasien kebidanan dengan infeksi COVID-19 di ruang Praja RSUD WANGAYA Bali. Untuk mengetahui karakteristik pasien kebidanan dengan infeksi COVID-19 di ruang Praja RSUD Wangaya Bali periode Mei 2020 - Desember 2020.

Metode: Penelitian deskriptif retrospektif dengan data catatan medik dari ibu terkait COVID-19. Kriteria inklusi merupakan pasien kebidanan dengan infeksi COVID-19 di ruang Praja dengan hasil Rapid Test atau RT-PCR reaktif di RSUD Wangaya. Data yang dikumpulkan adalah usia, paritas, skrining rapid test, komorbid, probable case, gejala klinis, hasil laboratorium, ronsen thorax, berat badan dan skor APGAR bayi, jenis persalinan, jumlah perdarahan post partum, confirm case dengan RT-PCR, lama perawatan, kebutuhan ruang rawat ICU dan jumlah yang meninggal.

Hasil: Pada penelitian ini terdapat 67 responden, sebagian besar berada dalam rentang usia 21-30 tahun dan sudah pernah melahirkan lebih dari satu kali. Lebih dari separuh responden jenis persalinannya merupakan seksio sesaria, dan sebagian besar responden positif COVID-19 melalui tes RT-PCR. Skor APGAR dan berat badan bayi sebagian besar normal. Terdapat 62 responden terkonfirmasi RT-PCR, sedangkan dengan hasil Rapid reaktif, sebanyak 66 orang. Ditemukan pasien dengan keadaan anemia ringan, serta di dapatkan adanya peningkatan jumlah CRP dan Neutrofil. Pasien tanpa gejala dan tanpa komorbid paling banyak dijumpai dan pada gambaran ronsen terbanyak mengalami pneumonia. Tidak terdapatnya perdarahan post partum pada kedua metode persalinan. Hanya 1 orang yang memerlukan ruangan ICU. Pasien terinfeksi COVID-19 memerlukan waktu perawatan yang lebih lama.

Kesimpulan: Sebagian besar ditemukan dalam tanpa kmorbid dan tanpa gejala. Hasil laboratorium sebagian besar ditemukan dengan anemia ringan, leukositosis dengan neutrofilia dan NLR tinggi, serta CRP tinggi. Sebagian besar ibu hamil tidak mebutuhkan perawatan ICU.

The prevalence between stress and acne vulgaris among medical students at Universitas Udayana in the 2019 period

Background: Acne vulgaris is a common disease in medical students. One of the causes of acne vulgaris is stress. Acne vulgaris can affect the quality of life associated with one's self-confidence. But often, this disease is ignored and not treated properly. This study aims to know if acne vulgaris occurs in students at the Faculty of Medicine, Universitas Udayana, Bali, Indonesia, related to the stress that affects acne vulgaris.

Methods: This research is a descriptive cross-sectional study. Data is collected using a data retrieval form. The inclusion criteria in this study were: 1) Participants selected must be from English class from semester 7 and aged 20 or above; 2) Participants can be from both genders; and 3) Participants that join the study willingly. Besides, the exclusion criteria were respondents who did not approve as a research sample and did not fill out informed consent. Data were analyzed using SPSS version 17 for Windows.

Results: About 62 of 93 study participants were diagnosed with acne vulgaris in students at the Faculty of Medicine, Universitas Udayana. There were 31 of 62 study participants who were diagnosed with acne vulgaris due to stress. Women had more acne vulgaris than men and the number of students that had acne vulgaris the most are at the age of 21. The most common type of lesion is comedonal with a mild classification level. Most of the subject's cause of acne due to stress is before block exam. Most of the participants feel embarrassed due to acne. About 24.2% of the subjects had a habit of scratching/squeezing acne vulgaris.

Conclusion: Most of the subjects diagnosed with acne were female and age 21 years old. Besides, comedones were the predominant type of lesion, followed by a mild degree of acne severity.

Antibiogram and biofilm formation among extended-spectrum ?-lactamase-producing Klebsiella pneumoniae clinical isolates in Sanglah General Hospital, Bali, Indonesia

Background: Klebsiella pneumoniae is a common cause of healthcare-associated infections (HAIs), and has a high level of resistance to antibiotics first, second, extended-spectrum cephalosporins, and monobactam which are a serious threat to public health worldwide. Besides, it is known that this bacterium can form biofilms as virulence factors that contribute to drug resistance. This study aims to determine the antibiotics susceptibility patterns and the capacity of K. pneumoniae to form biofilms.

Methods: K. pneumoniae was isolated from clinical specimens (urine, sputum, pus, blood, and others) for the period 2018-2019. Bacterial identification and antibiotic susceptibility testing were performed using the Vitek Compact 2 (bioMérieux®) test in the Clinical Microbiology Laboratory of Sanglah General Hospital. Biofilm formation was checked using the tissue culture plate method (TCP). Data were analyzed using SPSS version 20 for Windows.

Results: Most of Extended Spectrum ?-Lactamase (ESBL)-producing K. pneumoniae showed resistance to antibiotics. The susceptible profiles were only towards ertapenem (97.50%), meropenem (97.50%), amikacin (95.00%), and tigecycline (87.50%). The TCP method detected 72 (90.00%) as biofilm producers among 80 clinical isolates, while 8 (10.0%) as non-biofilm producers. Among the biofilm-producer bacteria, there were 6 (7.50%) as strong, 37 (46.25%) moderate, and 29 (36.25%) weak biofilm-producer isolates.

Conclusions: Most ESBL-producing K.pneumoniae clinical isolates in Sanglah General Hospital demonstrate multiple resistance to antibiotics and as biofilm producers. However, further research is needed to be conducted using a molecular approach to see the ESBL- and biofilm-encoded genes.

Perbandingan efektivitas ketorolac, deksketoprofen, dan parasetamol dalam mengurangi rasa nyeri dengan menggunakan penilaian visual analogue scale (VAS) pada pasien pasca pembedahan ortopedi ekstremitas inferior di RSUD Nganjuk, Jawa Timur, Indonesia

Background: Pain is an unpleasant emotional and subjective sensory experience which is associated with real tissue damage, potentially damaging, or describing the conditions in which the damage occurred. The use of non-steroidal anti-inflammatory drugs (NSAIDs) as an analgesic to treat postoperative pain is one of the standard therapies. This study aims to examine various types of analgesics in pain management in patients after orthopedic surgery of the inferior extremities at Nganjuk Hospital, East Java.

Methods: This cross-sectional experimental study was conducted on 15 patients after inferior limb surgery at Nganjuk Hospital in the period May 2015 - June 2015. Data on the effectiveness of ketorolac, dexketoprofen, and paracetamol in reducing pain through VAS assessment were analyzed by SPSS version 20 for Windows.

Results: Most of the men in this study (66.70%). There was a decrease in the mean VAS value between examination II (24 hours) and I (8 hours) both in the group that received ketorolac injection 30 mg/ml (3.80±0.44), dexketoprofen 50 mg/2 ml (3.00±1.00), and paracetamol 1000 mg/100 ml (2.40±5.40).

Conclusion: The results of this study indicate that the decrease in the mean VAS value as a parameter of pain was found to be greatest in the group with 30 mg / ml ketorolac injection within 24 hours.

Latar Belakang: Nyeri adalah pengalaman sensoris subjektif dan emosional yang tidak menyenangkan dimana terkait dengan kerusakan jaringan yang nyata, berpotensi merusak, atau menggambarkan kondisi terjadinya kerusakan. Penggunaan obat golongan Non-Steroid Anti Inflammatory Drugs (NSAID) sebagai analgesik untuk mengatasi nyeri pasca pembedahan merupakan salah satu standar terapi. Penelitian ini bertujuan untuk mengkaji berbagai jenis analgesik dalam manajemen nyeri pada pasien pasca pembedahan ortopedi ekstremitas inferior di RSUD Nganjuk, Jawa Timur.

Metode: Penelitian eksperimental potong-lintang ini dilakukan terhadap 15 pasien pasca bedah ekstremitas inferior di RSUD Nganjuk pada periode Mei 2015 – Juni 2015. Data tentang efektivitas ketorolac, deksketoprofen, dan parasetamol dalam mengurangi rasa nyeri melalui penilaian VAS dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Sebagian besar pada penelitian ini berjenis kelamin laki-laki (66,70%). Terdapat penurunan rerata nilai VAS antara pemeriksaan II (24 jam) dan I (8 jam) baik pada kelompok yang mendapatkan injeksi ketorolac 30 mg/ml (3,80±0,44), deksketoprofen 50 mg/2 ml (3,00±1,00), dan parasetamol 1000 mg/100 ml (2,40±5,40).

Kesimpulan: Hasil penelitian ini menunjukkan bahwa pemberian penurunan nilai rerata VAS sebagai parameter terhadap nyeri ditemukan paling besar pada kelompok dengan injeksi ketorolac dosis 30 mg/ml dalam waktu 24 jam.

Karakteristik penderita mioma uteri di Rumah Sakit TK II Putri Hijau Medan Kesdam-I / BB Tahun 2013

Background: Uterine myoma is a benign tumor in the uterine area, or more precisely the uterine muscle and connective tissue around it. The incidence of uterine myoma is still high and increasing from year to year. This study aimed to determine the characteristics of patients with uterine myoma at Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB in 2013.

Methods: This study was a descriptive study with a cross sectional approach, using medical record data at Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB. The sample of this study were all patients with uterine myoma who were hospitalized at Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB in 2013, as many as 115 cases. All data were analyzed descriptively.

Results: Of the 115 samples taken, 95 samples met the inclusion criteria. The results showed the distribution of the characteristics of uterine myoma patients at Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB in 2013 based on the highest sociodemographic factors were aged 35-50 (84.2%), high school education (73.6%), house wives (72.6%). Based on obstetric medico factors, primipara (45.3%) was the most common. The most common symptom was abnormal bleeding (24.2%). The most common type of myoma was submucous myoma (65.3%). The most radiological examination was USG (97.9%). The most common treatment was hysterectomy (66.3%).

Conclusion: Most uterine myoma patients was at the age of 35-50 years, high school education, work as housewives, primiparous. The most common symptom was abnormal bleeding, with a submucosal myoma type. The most common treatment done was hysterectomy.

Latar belakang: Penyakit tumor jinak pada otot dan jaringan sekitar dari rahim yang masih menjadi permasalahan hingga saat ini adalah mioma uteri. Kejadian mioma uteri menunjukkan peningkatan seiring dengan waktu. Penelitian ini bertujuan untuk mengetahui karakteristik penderita mioma uteri di Rumah Sakit TK II Putri Hijau Medan Kesdam-I / BB Tahun 2013.

Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan cross sectional, menggunakan data rekam medis di Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB. Sampel penelitian ini adalah seluruh penderita mioma uteri yang rawat inap di Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB tahun 2013 yaitu sebanyak 115 kasus. Seluruh data dilakukan analisis deskriptif.

Hasil: Dari 115 sampel yang diambil, 95 sampel yang memenuhi kriteria inklusi. Hasil penelitian menunjukan distribusi karakteristik penderita mioma uteri di Rumah Sakit TK II Putri Hijau Medan Kesdam-I/BB tahun 2013 berdasarkan faktor sosiodemografi tertinggi yaitu usia 35 – 50 (84,2%), pendidikan SMA (73,6%), pekerjaan Ibu rumah tangga (72,6%). Berdasarkan faktor mediko obstetri yaitu primipara (45,3%). Gejala yang terbanyak adalah perdarahan abnormal (24,2%). Jenis mioma yang terbanyak adalah mioma submukosa (65,3%). Pemeriksaan radiologi yang terbanyak adalah USG (97,9%). Penanganan yang terbanyak adalah Histerektomi (66,3%).

Simpulan: Penderita mioma uteri terbanyak pada umur 35–50 tahun, pendidikan SMA, berprofesi sebagai ibu rumah tangga, primipara. Gejala yang paling sering timbul adalah perdarahan abnormal, dengan jenis mioma submukosa, Penanganan yang paling banyak dikerjakan adalah histerektomi.

Faktor-faktor yang berhubungan dengan kejadian asfiksia neonatorum di RSUD Sanjiwani, Gianyar

Introduction: Asphyxia neonatorum is a condition in which the newborn does not breathe spontaneously, regularly and adequately. The incidence of asphyxia is one of the three leading causes of death in neonates in developing countries with an estimated 21-30%. Asphyxia can result. Asphyxia can cause a variety of adverse short-term and long-term complications. Objective: The aim of this study is to know the correlation between risk factors of asphyxia in Sanjiwani hospital, Gianyar.

Methods: This research is a cross-sectional observational analytic study.  Newborn who was diagnosed with asphyxia in Sanjiwani hospital between January 2019- December 2019 were included. Data, such as maternal age, mode of delivery, preeclampsia, premature rupture of membranes, prolong labor, low birth weight, premature and placental abnormalities were collected from medical record. The data were processed and analyzed univariate and bivariate using Chi-square test dan Fisher exact test to get prevalence ratio (PR). The value of p<0,05 was considered significant.

Results: The results showed that out of 162 cases, 46.9% of newborns had asphyxia. A bivariate analysis showed significant correlation between asphyxia and premature rupture of membranes (PR=1,748, p=0,041, CI 95% 1,211 - 3,582)), mode of delivery (PR=1,975, p=0,039: CI 95% 1,032 – 3,780), low birth weight (PR=3,662, p=0.001; IK 95% 1,733 - 7,738), premature (PR=2,461, p=0.014; CI 95% 1,185 - 5,114) dan placental abnormality (PR=8,623, p=0,018; CI 95% 1,036 - 71,785).

Conclusion: Premature rupture of membranes, mode of delivery, low birth weight, premature and placental abnormalities are risk factor that associated with neonatal asphyxia. Early detection in these risk factors was essential to decreased asphyxia.

Pendahuluan: Asfiksia neonatorum merupakan suatu kondisi dimana bayi baru lahir tidak bernapas secara spontan, adekuat dan teratur. Kejadian asfiksia adalah salah satu dari tiga penyebab kematian terbanyak pada neonatus di negara berkembang dengan perkiraan sekitar 21-30%. Asfiksia dapat menimbulkan berbagai komplikasi jangka pendek dan jangka panjang yang merugikan. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan asfiksia neonatorum di RSUD Sanjiwani Gianyar

Metode: Penelitian ini merupakan penelitian analitik observasional potong lintang. Sampel penelitian adalah bayi baru lahir yang terdiagnosis asfiksia neonatorum di RSUD Gianyar dalam kurun waktu Januari 2019 – Desember 2019. Data berupa usia maternal, metode persalinan, preeklampsia, ketuban pecah dini, partus lama, prematuritas, berat badan lahir rendah dan kelainan plasenta didapatkan dari rekam medis. Data kemudian dianalisis secara univariat dan bivariat dengan uji Chi-square dan Fisher exact, serta dilakukan analisis prevalence ratio (PR). Hubungan dikatakan signifikan apabila diperoleh nilai p<0,05.

Hasil: penelitian menunjukkan dari 162 sampel, sebanyak 46,9% bayi baru lahir mengalami asfiksia. Berdasarkan hasil uji bivariat didapatkan hubungan yang bermakna antara  kejadian asfiksia neonatorum dengan ketuban pecah dini (PR=1,748, p=0,041, IK 95% 1,211 - 3,582), metode persalinan (PR=1,975, p=0,039: IK 95% 1,032 – 3,780), berat badan lahir rendah (PR=3,662, p=0.001; IK 95% 1,733 - 7,738), prematur (PR=2,461, p=0.014; IK 95% 1,185 - 5,114) dan kelainan plasenta (PR=8,623, p=0,018; IK 95% 1,036 - 71,785).

Simpulan: Ketuban pecah dini, metode persalinan, berat badan lahir rendah, prematuritas dan kelainan plasenta merupakan faktor risiko yang berhubungan dengan terjadinya asfiksia neonatorum. Deteksi dini terhadap faktor risiko ini diharapkan dapat membantu menurunkan terjadinya asfiksia.

Hubungan antara pengetahuan dengan praktik pemenuhan gizi seimbang oleh ibu pada anak usia 1-5 tahun di Desa Pepelegi Kecamatan Waru Kabupaten Sidoarjo

Background: Practice of balanced nutrition fulfillment is an action to meet the nutritional needs of a person according to the needs of the body that can ultimately prevent the emergence of nutritional problems. Practice itself can be influenced by various factors, one of which is knowledge of balanced nutrition fulfillment.

Aim: The study aims to determine a correlation between knowledge and the practice of balanced nutrition fulfillment.

Methods: The observational analytic study involved randomly 63 samples of 882 maternal who had children aged 1-5 years in Pepelegi Village of Waru Sub-district, Sidoarjo Regency. The data consist of a knowledge group and practice one.

Results: There was a correlation between knowledge and practice of balanced nutrition fulfillment of the participants (p<0.05). Most of them aged 31-40 years, with the majority of highest education level was senior high school. Most participants had sufficient levels of knowledge and good balanced nutrition fulfillment practices.

Conclusion: Knowledge supplies a great practice of balanced nutrition fulfillment so either health promotion or counseling should be provided by the community health service.

Latar Belakang: Praktek pemenuhan gizi seimbang merupakan suatu tindakan untuk memenuhi nutrisi seseorang sesuai dengan kebutuhan tubuh yang pada akhirnya dapat mencegah timbulnya permasalahan gizi. Praktik sendiri dapat dipengaruhi oleh berbagai faktor, salah satunya pengetahuan tentang pemenuhan gizi seimbang.

Tujuan: untuk mengetahui hubungan antara pengetahuan dengan praktik pemenuhan gizi seimbang oleh ibu pada anak usia 1-5 tahun di Desa Pepelegi, Kecamatan Waru Kabupaten Sidoarjo.

Metode: Penelitian analitik observasional ini melibatkan 63 sampel dari 882 ibu yang memiliki anak usia 1-5 tahun di Desa Pepelegi yang diambil secara acak. Mereka dibagi sebagai kelompok pengetahuan dan kelompok praktek pemenuhan gizi seimbang.

Hasil: Terdapat hubungan antara pengetahuan dan praktik pemenuhan gizi seimbang (p<0,05). Sebagian besar responden berusia antara 31-40 tahun dengan mayoritas tingkat pendidikan terakhir adalah sekolah menengah atas (SMA). Sebagian besar responden memiliki tingkat pengetahuan yang cukup serta praktek pemenuhan gizi seimbang yang baik.

Simpulan: Pengetahuan turut mempengaruhi praktik pemenuhan gizi seimbang sehingga perlu penyuluhan berkesinambungan serta praktek pemenuhan gizi seimbang yang diberikan oleh puskesmas.

Terapi penghambat Sodium Glucose Co-Transporters-2 (SGLT-2) dalam pengobatan Diabetes Melitus Tipe-2 (DM-2): tinjauan pustaka

Management of type II diabetes mellitus is a science that continues to develop. Treatment of type II diabetes mellitus can affect various organ functions, one of which is the kidneys, which function to excrete glucose, namely SGLT II inhibitors. The class of sodium-glucose transport protein 2 (SGLT2) inhibitors has a new mechanism of action and is complementary to the older drugs used to treat type II diabetes. The sodium-glucose cotransporter-2 (SGLT2) protein is expressed in the proximal tubule of the renal convolution. These transporters are ideal targets for the treatment of diabetes because they account for approximately 90% of filtered glucose reabsorption SGLT2 inhibitors can be a useful option in obese and hypertensive patients because of their weight loss and antihypertensive benefits and thus benefit cardiovascular function. Patients at high risk for hypoglycemia may benefit from a combination of metformin and SGLT2 inhibitors because the risk of hypoglycemia with SGLT2 inhibitors is small when compared with insulin and sulfonylurea.

Tatalaksana DM mellitus tipe II merupakan ilmu yang terus berkembang. Pengobatan DM tipe II dapat mempengaruhi berbagai fungsi organ, salah satunya adalah ginjal yang berfungsi untuk mengeksreksikan glukosa  yakni penghambat SGLT II. Kelas obat penghambat sodium-glukosa transport protein 2 (SGLT2) memiliki karakteristik ini, dan mekanisme aksi yang baru melengkapi obat yang lebih lama yang digunakan untuk mengobati DM tipe II. Protein sodium-glukosa cotransporter-2 (SGLT2) diekspresikan dalam tubulus proksimal konvolusi ginjal. Transporter ini adalah target yang ideal untuk pengobatan diabetes karena mereka bertanggung jawab atas sekitar 90% dari reabsorpsi glukosa yang difiltrasi Inhibitor SGLT2 dapat menjadi pilihan yang berguna pada pasien obesitas dan hipertensi karena penurunan berat badan dan manfaat antihipertensi sehingga memberikan manfaat terhadap fungsi kardiovaskular. Pasien yang berisiko tinggi untuk hipoglikemia dapat mengambil manfaat dari kombinasi metformin dan inhibitor SGLT2 karena risiko hipoglikemia dengan inhibitor SGLT2 kecil jika dibandingkan dengan insulin dan sulfonylurea.

Perbandingan kapasitas vital paru dan FEV1 antara atlet olahraga aerobik dan nonatlet: sebuah tinjauan sistematik

Introduction: Physical exercise, such as aerobic exercise, depends on the aerobic energy generation process or requires oxygen. One way to determine the benefits of physical activity in individuals is to look at the differences in lung function in the group who regularly exercise (athletes) with the sedentary group. This review will discuss further the comparison of vital lung capacity and Forced Expiratory Volume in 1 sec (FEV1), which is presented in the form of a systematic review.

Methods: A search for journals published from 2015-2020 was conducted on the CENTRAL, ProQuest, Pubmed, and ScienceDirect databases that compared cardiorespiratory endurance values in athletes and non-athletes. The preparation of this systematic review is based on guidelines for writing systematic reviews by Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA).

Results: The literature search results in 30 studies. These studies were analyzed based on the intervention or exposure to see the description and differences of lung function characteristics, especially vital capacity and FEV1 in aerobic and non-athletic athletes.

Conclusion: Aerobic sports athletes tend to have better lung function than non-athletes, where lung function is assessed based on the higher FVC and FEV1 values in aerobic athletes. Several studies that showed insignificant differences on the lung function of aerobic athletes and non-athletes were caused by differences in the anthropometric characteristics of each group, which was a confounding factor in the study. 

Pendahuluan: Latihan fisik seperti olahraga aerobik merupakan aktivitas fisik yang bergantung pada proses pembentukan energi secara aerob dan dapat memberikan efek positif terhadap sistem kardiovaskular dan respirasi. Salah satu cara untuk mengetahui manfaat aktivitas fisik pada individu adalah dengan melihat perbedaan fungsi paru pada kelompok yang rutin berolahraga (atlet) dengan kelompok sedenter. Dalam tinjauan ini akan dibahas lebih jauh mengenai perbandingan kapasitas vital paru dan Forced Expiratory Volume in 1 sec (FEV1) yang disajikan dalam bentuk tinjauan sistematik.

Metode: Pencarian jurnal yang membandingkan nilai daya tahan kardiorespirasi pada atlet dan nonatlet yang diterbitkan dari tahun 2015-2020 melalui database CENTRAL, ProQuest, Pubmed, dan ScienceDirect. Penyusunan systematic review ini didasarkan pada pedoman penulisan tinjauan sistematik oleh Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Hasil: Hasil pencarian literatur berupa 30 studi yang relevan dan kemudian dianalisis berdasarkan pada intervensi atau paparan yang dilakukan untuk melihat gambaran serta perbedaan karakteristik fungsi paru khususnya kapasitas vital dan FEV1 pada atlet aerobik dan nonatlet.

Simpulan: Atlet olahraga aerobik cenderung mempunyai fungsi paru yang baik jika dibandingkan dengan non-atlet, dimana fungsi paru ini dinilai berdasarkan lebih tingginya nilai FVC dan FEV1 pada atlet aerobik. Beberapa studi yang menunjukkan hasil tidak signifikan terhadap fungsi paru atlet aerobik dan nonatlet disebabkan oleh adanya perbedaan karakteristik antropometri dari masing-masing kelompok dimana hal ini merupakan faktor perancu dalam penelitian.

Gambaran hingga tatalaksana COVID-19 pada anak

Background: Coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus started in Wuhan, China, spreading rapidly to various countries. This literature review aims to provide an overview, diagnosis and management of COVID-19 in children.

Methods: In this paper, the literature review method is used. Sources of reading come from relevant and appropriate journals and books from PubMed, Ebsco and Proquest.

Results: Based on data from the Indonesian Ministry of Health dated January 15, 2021, it shows that 2.7% of confirmed cases of COVID-19 are children aged 0-5 years, and 8.9% children aged 6- 18 years. The mortality rate for COVID-19 in children aged 0-5 years is 0.8% and aged 6-18 years is around 1.5%. The most common pattern of transmission of COVID-19 to children is from family clusters. Symptoms and signs of COVID-19 in children include fever, cough, rhinorrhea, painful swallowing, weakness, lacrimation, headache, diarrhea, vomiting, cyanosis and in severe cases Multisystem Inflammatory Syndrome COVID-19 (MIS-C). Diagnosis of COVID-19 in children is confirmed from clinical symptoms and supportive laboratory results such as low to normal leukocytes, increased CRP and radiological abnormalities such as hazy opacities on X rays and ground glass appearance on thoracic computed tomography (CT), despite Real Time Polymerase Chain Reaction ( RT-PCR) is the standard method for diagnosing this disease. General management of children with COVID-19 in the form of complete rest, supportive therapy, symptomatic therapy, administration of vitamins and monitoring of vital signs and oxygen supplementation. Antiviral therapy, antibiotics and steroids are given as indicated. The COVID-19 vaccine for children is currently in the process of being researched.

Conclusion: The COVID-19 pandemic is spreading rapidly, and confirmed cases in children are increasing significantly. The prevalence of COVID-19 in children tends to be lower and most of them have milder symptoms than adults, but proper diagnosis and management is needed.

Latar Belakang: Coronavirus disease (COVID-19) disebabkan oleh virus SARS-CoV-2 diawali di Wuhan, Cina menyebar dengan cepat ke berbagai negara. Tinjauan pustaka ini bertujuan memberikan gambaran, diagnosis dan tatalaksana COVID-19 anak.

Metode: Dalam penulisan ini digunakan metode tinjauan pustaka. Sumber bacaan berasal jurnal-jurnal dan buku relevan dan sesuai dari PubMed, Ebsco dan Proquest.

Hasil: Berdasarkan data Kementrian Kesehatan Indonesia tanggal 15 Januari 2021 menujukkan 2,7 % kasus terkonfirmasi COVID-19 adalah anak usia 0-5 tahun, dan 8,9% anak usia 6- 18 tahun. Angka Kematian COVID-19 pada anak usia 0-5 tahun adalah 0,8% dan usia 6-18 tahun sekitar 1,5%. Pola tersering penularan COVID-19 pada anak adalah berasal dari kluster keluarga. Gejala dan tanda COVID-19 pada anak meliputi demam, batuk, rhinorrhea, nyeri menelan, lemas, lakrimasi, nyeri kepala, diare, muntah, sianosis dan pada kasus berat terjadi Multisystem Inflammatory Syndrome COVID-19 (MIS-C). Diagnosa COVID-19 anak ditegakkan dari gejala klinis dan hasil laboratorium mendukung seperti leukosit yang rendah ke normal, peningkatan CRP dan abnormalitas radiologis seperti hazy opacities pada X ray dan ground glass appearance pada Computed Tomography (CT) toraks, meskipun Real Time Polymerase Chain Reaction (RT-PCR) merupakan metode baku untuk menegakkan diagnosis penyakit ini. Tatalaksana umum pasien COVID-19 anak berupa istirahat total, terapi suportif, terapi simtomatik, pemberian vitamin serta pemantauan tanda vital dan suplementasi oksigen. Terapi antivirus, antibiotik, dan steroid diberikan sesuai indikasi. Vaksin COVID-19 anak saat ini masih dalam proses penelitian.

Kesimpulan: Pandemi COVID-19 meyebar dengan cepat, dan kasus terkonfirmasi pada anak meningkat secara signifikan. Prevalensi COVID-19 anak cenderung lebih rendah dan sebagian besar memiliki gejala yang lebih ringan dibanding dewasa namun diagnosis dan tatalaksana yang tepat sangat diperlukan.

Mengenal New Psychoactive Substances (NPS): sebuah tinjauan pustaka

Drug abuse is a global phenomenon that is difficult to control. Until now, various types of narcotics have been distributed in many countries, one of which is New Psychoactive Substances (NPS). Despite its fast growing and massive spread, NPS is still a new substance, considering the little number of data recorded up to recent days. This also results in difficulty of NPS identification in toxicological samples . The use of NPS is associated with many health problems, which causes physical and psychological disturbance potentially more severe than ordinary narcotics. This review aims to summarize the existing literature on NPS that focuses on identifying the types of NPS substances and symptoms as well as the management which could be provided to the patients.

Penyalahgunaan narkotika merupakan fenomena global yang sulit dikendalikan, hingga saat ini variasi narkotika telah beredar di begitu banyak negara salah satunya termasuk Zat Psikoaktif Baru atau New Psychoactive Substances (NPS).  Terlepas dari penyebarannya yang cepat dan masif, masih banyak orang yang belum memiliki pengetahuan akan NPS mengingat pendataan zat-zat ini masih sedikit dilakukan. Hal tersebut juga menyebabkan identifikasi NPS dalam sampel toksikologi masih sulit dilakukan. Padahal penggunaan NPS sering dikaitkan dengan masalah kesehatan, dimana efek yang ditimbulkan dapat menyebabkan gejala gangguan fisik dan psikologis yang lebih berat dibandingkan zat narkotika pada umumnya. Tinjauan ini dibuat untuk merangkum literatur yang ada mengenai NPS yang berfokus pada pengenalan jenis-jenis zat NPS serta gejala juga tatalaksana yang dapat diberikan pada pasien pengguna NPS.

Manifestasi dan transmisi okular pada coronavirus disease 2019 (COVID-19): klinis dan pencegahan

Background: Coronavirus disease 2019 (COVID-19) pandemic is an infectious disease caused by a novel Coronavirus called Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Respiratory tract is the main route for this virus transmission through droplets, with common symptoms as fever, cough and dyspnea. Beside the manifestation on the respiratory track, patient with COVID-19 can also have ocular complaints.

Methods: In writing this article, the literature review method was used and sources consist of relevant journals obtained through online search engines.

Results: Conjunctivitis and keratoconjunctivitis was the most ocular manifestation reported on patients. The eye can be one of the entry routes for the virus because of the connection between the upper respiratory tract and the ocular surface mucosa through the nasolacrimal duct.

Conclusion: The ocular manifestation in COVID-19 patients must not be ignored. The eye can be port of entry of the virus. Therefore, it is important to know the ocular manifestation and prevent the transmission of COVID-19.

Latar belakang: Pandemi coronavirus disease 2019 (COVID-19) merupakan suatu penyakit infeksius yang disebabkan oleh novel coronavirus yang disebut sebagai Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Saluran pernapasan merupakan jalur utama penyebaran virus ini, yaitu melalui droplet, dengan gejala umum berupa demam, batuk disertai dispnea. Selain bermanifestasi pada saluran pernapasan, COVID-19 juga dapat bermanifestasi pada okular.

Metode: Dalam penulisan artikel ini digunakan metode tinjauan pustaka dengan bersumber pada artikel relevan yang didapatkan melalui pencarian secara daring.

Hasil: Konjungtivitis dan keratokonjungtivitis merupakan beberapa manifestasi okular yang paling sering dilaporkan pada pasien dengan COVID-19. Mata dapat menjadi salah satu jalur masuk virus oleh karena adanya hubungan saluran pernapasan atas dan mukosa permukaan okuli melalui duktus nasolakrimalis.

Simpulan: Manifestasi okular pada COVID-19 tidak dapat diabaikan. Mata dapat menjadi salah satu port de entry virus. Oleh sebab itu, mengenali gejala pada okular serta pencegahan trasnsmisi okular virus COVID-19 menjadi sangatlah penting.

Hubungan indeks massa tubuh (IMT) terhadap kejadian psoriasis: sebuah tinjauan sistematik

Background: Psoriasis is a chronic inflammatory disease associated with body mass index (BMI)  25 or obesity. This study aimed to look at the association between BMI and the incidence of psoriasis.

Methods: This systematic review is done due to PRISMA statement guidelines. The search was conducted in Pubmed and PubMed Central database from 2015-2019 with inclusion age >18, BMI  25 and the results of Hazard Ratio (HR) and Odds Ratio (OR). The title and abstract of these articles were reviewed for relevance, based on inclusion criteria. This systematic review uses STROBE to evaluate the individual study's quality, which consists of 22 domains.

Results:  In the final stage, this systematic review identifies four articles. Overall, the quality of these four articles based on the STROBE checklist is pretty good.  As much as two studies supported the association between BMI and psoriasis, the other two studies did not have any association.

Conclusion: Overall, this systematic review shows that older age is found to have a higher effect on psoriasis. However, studies that support the existence of an association have incomplete control variables that can potentially lead to bias. Until now, the correlation between BMI and psoriasis remains unclear since many articles show contradicting results

Latar Belakang: Psoriasis merupakan salah satu penyakit inflamasi kulit autoimun, bersifat kronik yang berhubungan dengan indeks massa tubuh (IMT)  25 atau obesitas. Tujuan dari penelitian ini adalah untuk melihat hubungan antara IMT dan kejadian psoriasis.

Metode: Penulisan tinjauan sistematik ini dilakukan berdasarkan pedoman PRISMA. Pencarian artikel dilakukan pada database Pubmed dan PubMed Central dari tahun 2015-2019 dengan kriteria inklusi >18 tahun, IMT 25 dan hasil Hazard Ratio (HR) dan Odds Ratio (OR). Judul dan abstrak ditinjau berdasarkan relevansi penelitian. Penilaian kualitas studi dilakukan berdasarkan checklist STROBE yang terdiri dari 22 domain.

Hasil: Pada tahap akhir didapatkan sebanyak empat artikel. Secara umum kualitas studi keempat artikel berdasarkan checklist STROBE cukup baik. Studi yang mendukung hubungan antara IMT dan psoriasis sebanyak dua dan yang tidak mendukung sebanyak dua.

Kesimpulan: Tinjauan sistematik ini menunjukan bahwa faktor usia lebih tua ditemukan pengaruh yang lebih tinggi terhadap psoriasis. Namun, artikel yang mendukung adanya hubungan antara IMT dan psoriasis memiliki variabel kontrol yang tidak lengkap sehingga berpotensi bias. Sampai saat ini hubungan antara IMT dan psoriasis belum didukung oleh bukti yang kuat, karena dari artikel-artikel yang tersedia masih banyak yang bertentangan.

Left scapulothoracic dissociation with floating shoulder and grade IIIC open left clavicle fracture with Ideberg type III scapula fracture: a rare case report

Background: A high-energy trauma can cause fractures involving clavicle, scapula, and scapulothoracic dissociation with floating shoulder and vascular injuries. Early and correct diagnosis of fracture with vascular injury should be performed to prevent the patient from mortality. This case report aims to evaluate the left scapulothoracic dissociation with floating shoulder and grade IIIC open left clavicle fracture with Ideberg type III scapula fracture

Case Presentation: A 19 years old male was on a motorcycle-truck accident which was diagnosed with a rare left scapulothoracic dissociation with floating shoulder and grade IIIC open left clavicle fracture with Ideberg type III scapula fracture. The patient underwent arteriography, repair of the vascular injury, and open reduction internal fixation for the fracture.

Conclusion: A rare and complex case of scapulothoracic dissociation with floating shoulder and traumatic subclavian artery injury and clavicle with scapula fractures require early recognition and a multi-disciplinary approach to manage the injuries.

Anomalies of the sigmoid colon during laparotomy exploration: a case report of a redundant colon in the sigmoid and transverse colon

Introduction: The redundant colon is rare, often resulting in a late diagnosis because it is often asymptomatic and eventually leads to complications. The average person has a large intestine/colon 120-150 cm long in his abdominal cavity. The large intestine organ does not extend to the side but is tortuous to occupy the abdominal cavity. An abnormal condition can be found in the intestine length is beyond normal, known as “redundant colon”. The redundant colon may have additional loops or turns, which cause it to become longer. In people who experience the redundant colon, the process of removing feces in the body tends to be longer, so it often experiences constipation.

Case description: In this case, A 40-year-old patient of female gender reportedly came to the BIMC Hospital and complaints of her abdominal pain, unable to defecate for 3 weeks ago, and did not improve with enemas. The patient had a history of total hysterectomy 13 years ago. The abdomen's physical examination is distended while inspected, there is no tenderness during palpation, and has normal auscultation. CT-Scan investigation found redundant transverse colon, low ileocecal junction location, and many intraluminal (colonic) stools, as well as plain abdominal images with obstruction of the large intestine. In patients, an exploratory laparotomy has been performed.

Conclusion: Ileus obstruction was found due to momentum adhesion which tangled the sigmoid colon and was redundant in the transverse colon during the surgery. With proper management of this case, we hope this surgery can attain this case back to normal.

Constipation that needs attention: late Hirschsprung disease

Background: Hirschprung disease (HD) or congenital aganglionic megacolon is an intestinal motor disorder that occurs in approximately 1 in 5000 live births. It makes colon fail to relax, mainly producing the symptoms of constipation. Approximately 90% of cases are diagnosed in the first year of life. Most of the remaining 10% are made in early childhood, with less than 1% being made in teenagers or adulthood.

Case report: A 13 years old girl reported to the pediatric surgical outpatient department complaining constipation since birth. There was no history of delayed passage of meconium. A contrast enema study with water-soluble contrast showed high probability of ultrashort segment HD. Histopathological examination revealed neither nerve fibers with ganglion cells nor hypertrophy of nerve fibers were seen confirming the aganglionosis. Surgical treatment was performed with good clinical progression.

Conclusion: Despite of its rarity, the possibility of HD should be considered in teenagers with chronic refractory constipation, especially when there was a history of delayed or non-passage of meconium after birth. An accurate diagnosis is mainly based on collective assessment of medical history, clinical examination, contrast enema study, and rectal biopsy as a gold standard.

Anemia defisiensi besi pada pasien dengan ulkus peptikum: Laporan kasus

Background: Anemia is a decrease in hemoglobin levels from the standard limit that can be caused by iron deficiency and chronic bleeding. One-third (32.9%) of the world population is estimated to suffer from anemia, and iron deficiency is a common cause of anemia in all countries. The diagnosis is made through history taking, physical examination and investigations.

Case report: 59-year-old male patient with complaints of black stool, abdominal pain and weakness. On physical examination, found pale conjunctiva, angular stomatitis and atrophy of the tongue. On complete blood, the examination found a decrease in erythrocyte levels, hemoglobin, MCV, MCH, and MCHC and increased RDW-CV. Analysis of peripheral blood smears presents with hypochromic microcytic poikilocytosis anemia, serum iron is decreased, and increased TIBC. Chronic bleeding anemia accompanied by iron deficiency will cause ferritin levels to decrease or be normal to 60 µg / dl. The patient was diagnosed with peptic ulcers as seen from esophagoduodenoscopy and severe anemia caused by iron deficit and chronic bleeding. Patients were treated supportively with PRC transfusion, ferrous sulfate and vitamin C.

Conclusion: The patient’s iron deficiency anemia resulted from peptic ulcers, which caused chronic bleeding.

Latar belakang: Anemia merupakan kondisi dengan kadar hemoglobin yang lebih rendah dari nilai normal. Anemia dapat disebabkan akibat defisiensi besi atau perdarahan kronis. Sebesar sepertiga (32,9%) populasi didunia diperkirakan menderita anemia. Defisiensi besi merupakan penyebab umum anemia di seluruh negara. Penegakan diagnosis anemia dilakukan melalui anamnesis, pemerikaan fisik, dan pemeriksaan penunjang.

Laporan kasus: Pasien laki-laki 59 tahun dengan keluhan BAB hitam, nyeri perut dan lemas. Pada pemeriksaan fisik ditemukan konjungtiva anemis, stomatitis angularis dan atrofi papil lidah. Pada pemeriksaan darah lengkap ditemukan penurunan kadar eritrosit, Hemoglobin, MCV, MCH, dan MCHC, peningkatan RDW-CV. Pemeriksaan apusan darah tepi gambaran anemia bikromik mikrositer poikilositosis, serum besi menurun, dan peningkatan TIBC. Anemia perdarahan kronis disertai defisiensi besi akan menimbulkan kadar ferritin menurun atau normal hingga 60µg/dl. Pasien didiagnosis dengan ulkus peptikum dilihat dari hasil Esofagoduodenoskopi dan anemia berat yang disebabkan oleh defisensi besi dan perdarahan kronis.  Pasien diterapi suportif dengan Tranfusi PRC, pemberian ferrous sulphate dan vitamin C.

Kesimpulan: Anemia defisiensi besi pada pasien ditimbulkan oleh ulkus peptikum yang menyebabkan terjadinya perdarahan kronis.

Fistulectomy in a 9-years old boy with pre-auricular fistula

Introduction: Preauricular fistule is a congenital malformation of the six auditory hillocks during the development of auricle. It mostly appears like a small pit close to the first ascending portion of the helix's anterior margin. The sebaceous glands secreted fluid through the opening of the fistule. Surgery is needed if the discharge is prolonged or if there was a repeated infection. It must be completely removed to prevent a recurrence. Accuracy is required in performing fistulectomy and aesthetics because the operation is in the area around the face.

Case description: Male patient, 9 years old, complained of itching in the right ear. Since birth, the patient has an abnormal hole (fistule) in front of his right ear, anterior of the medial supra auricle helix, round and the size of a tip of the pencil. The mother has the same history. There is an abscess near that hole that secretes yellow pus. That occurred twice this year and it has greatly disturbed the patient's activities at school. The patient was diagnosed with a preauricular fistula with an abscess in the right ear. An abscess drainage incision was performed and an antibiotic was given. Fistulectomy is performed after the acute infection subsides under general anesthesia. The patient underwent a simple fistulectomy surgery. The whole track and sinus were removed, the defect was undermined and sutured.

Conclusion: A simple fistulectomy is a good option as a standard procedure for preauricular fistula excision. It is especially useful as an alternative in cases where the other approaches are difficult to be performed.

Glaukoma sekunder pada pasien anak dengan Sindrom Sturge Weber: laporan kasus

Background: Sturge Weber's Syndrome (SSW) is a rare congenital disorder characterized by hemangiomas found in several parts of the body, such as the ocular, intracranial, and facial skin structures. Patients with SSW often experience glaucoma as one of the frequent ocular manifestations which can occur from birth or throughout life and can cause blindness. This case report aims to report the management of a pediatric patient with SSW who underwent trabeculectomy after failing to maintain intraocular pressure with topical drugs.

Case Presentation: A 5-year-old girl had increased intraocular pressure and optic nerve glaucoma signs in her right eye. This patient also had a birthmark in the form of a port-wine stain on her face's right side. After undergoing several tests, the patient was diagnosed with secondary glaucoma due to SSW with poor intraocular pressure control after 1.5 years of topical selective beta-blocker treatment. Trabeculectomy + 5-fluorouracil (5-FU) is performed to reduce intraocular pressure and prevent worsening of glaucoma. On the first day after surgery, the intraocular pressure was 20 mmHg in the right eye and decreased significantly during follow-up.

Conclusion: Trabeculectomy is one of the treatment options to treat glaucoma in SSW patients, which results in reasonable control of intraocular pressure.

Latar Belakang: Sindrom Sturge Weber (SSW) adalah kelainan bawaan yang jarang terjadi dimana ditandai dengan adanya hemangioma yang terdapat pada beberapa bagian tubuh, seperti struktur kulit okuler, intrakranial, dan wajah. Pasien dengan SSW sering mengalami glaukoma sebagai salah satu manifestasi okuler yang sering terjadi dimana dapat muncul sejak lahir maupun sepanjang masa kehidupannya serta dapat menyebabkan kebutaan. Laporan kasus ini bertujuan untuk melaporkan penatalaksanaan pada pasien anak dengan SSW yang menjalani prosedur trabekulektomi setelah gagal mempertahankan tekanan intraokuler dengan obat topikal.

Presentasi Kasus: Seorang anak perempuan berusia 5 tahun mengalami peningkatan tekanan intraokuler dan tanda-tanda saraf optik glaukoma di mata kanannya. Pasien ini juga memiliki tanda lahir berupa port wine stain di bagian kanan wajahnya. Setelah menjalani beberapa pemeriksaan, pasien terdiagnosa menderita glaukoma sekunder oleh karena SSW dengan kontrol tekanan intraokuler yang buruk setelah 1,5 tahun menjalani pengobatan topikal golongan beta bloker selektif. Operasi trabekulektomi + 5-fluorouracil (5-FU)dilakukan untuk menurunkan tekanan intraokuler dan mencegah perburukan glaukoma. Pada hari pertama setelah operasi, tekanan intraokuler menjadi 20 mmHg pada mata kanan dan berkurang secara bermakna selama masa tindak lanjut.

Kesimpulan: Trabekulektomi merupakan salah satu pengobatan pilihan untuk mengobati glaukoma pada pasien SSW yang menghasilkan kontrol tekanan intraokuler yang baik.

Priapism as an initial presentation in Chronic Myeloid Leukemia (CML): a case report

Background: Priapism is a persistent, usually painful erection that lasts for more than four hours and occurs without sexual stimulation. Priapism is a rare clinical sign of Chronic Myeloid Leukemia (CML), with an incidence of 1-5 cases per 100,000 people per year. In men who suffer from CML, ischemic priapism occurs secondary to hyperleukocytosis and venous obstruction by thrombus and microthrombus.

Case Presentation: In this case, a 24-year-old male, a Balinese ethnicity, present with prolonged erectile complaints accompanied by increased pain. From the examination performed, it was concluded that the patients had the ischemic type of priapism. From CBC, the patient was obtained hyperleukocytosis and continued with peripheral blood smear and bone marrow puncture. The patients concluded with CML, and initial intervention includes therapeutic aspiration, irrigation, hydroxyurea and other supportive therapies. It is a urological emergency requiring urgent treatment to prevent long-term complications, in particular erectile dysfunction.

Conclusion: Priapism is an unusual clinical manifestation of CML, whereas priapism is a urological emergency requiring immediate therapy. Treatment delay can cause complications of erectile dysfunction in men.  

Penatalaksanaan liken amiloidosis dengan desoksimetason dan asam salisilat topikal: laporan kasus

Background: Cutaneous amyloidosis is characterized by the deposition of amyloid material in the dermis or epidermis, usually limited to the dermal papillae in local cutaneous amyloidosis. Dermal involvement could lead to skin thickening with a waxy surface. The prevalence of cutaneous amyloidosis is relatively rare, only 0.2 – 0.3 % and is more common in individuals with darker skin phototype. The aim of this study is to report a case of lichen amyloidosis associated with its treatment using a combination of desoxymethasone and salicylic acid.

Case Report: We report a 27-year-old woman who came with multiple hyperpigmented papules, which were based on sharp-bordered brown macules with scales and lichenification that felt very itchy on both of her lower legs since 5 years ago. The same lesions also appeared on both her arms 2 years ago. She had skin phototype IV. She denied any history of chronic friction in those areas. On histopathological examination with hematoxylin and eosin (H&E) staining, amorphous deposits were found in the papillae dermis surrounded by melanophages. The patient was treated with topical therapy of 0.25% desoximetasone and 3% salicylic acid and was educated to avoid friction on the lesions. The patient admitted that the itchiness was reduced, but the lesion did not improve.

Result: Based on the patient’s age and sex, she belonged to a less common group affected by lichen amyloidosis. Phototype skin IV was the risk factor identified in this case. She denied any history of chronic friction on her skin. Lichen amyloidosis was diagnosed based on a typical lesion found at the predilection sites and was confirmed with histopathological examination with H&E staining. Topical desoximetasone and salicylic acid didn’t result in clinical improvement.

Conclusion: The diagnosis of lichen amyloidosis was confirmed with histopathological examination. H&E staining could demonstrate amyloid deposit clearly. Treatment of cutaneous amyloidosis is generally unsatisfactory and may require a combination of therapeutic modalities.

Latar Belakang: Amiloidosis kutaneus merupakan deposisi material amiloid pada lapisan dermis atau epidermis, umumnya terbatas hingga papilla dermis pada kasus amiloidosis kutaneus lokal. Keterlibatan dermis dapat menyebabkan penebalan kulit dengan permukaan seperti lilin. Prevalensi amiloidosis kutaneus relatif jarang yaitu hanya 0,2-0,3 % dan lebih sering terjadi pada individu dengan fototipe kulit lebih gelap. Tujuan penelitian ini untuk melaporkan kasus liken amiloidosis terkait dalam penatalaksanaannya menggunakan kombinasi desoksimetason dan asam salisilat. 

Laporan Kasus: Dilaporkan pasien perempuan berusia 27 tahun memiliki papul multipel dengan hiperpigmentasi, dasar kulit makula kecoklatan berbatas tegas disertai skuama dan likenifikasi yang terasa sangat gatal pada area kedua tungkai bawah sejak 5 tahun yang lalu. Lesi yang sama juga muncul pada kedua lengan sejak 2 tahun yang lalu. Pasien memiliki fototipe kulit IV. Pasien menyangkal riwayat gesekan kronis pada area tersebut. Pada pemeriksaan histopatologis dengan pewarnaan hematoxylin dan eosin (H&E), didapatkan deposit amorf di dalam papilla dermis dikelilingi melanofag. Pasien mendapatkan terapi krim topikal desoksimetason 0,25 % dan asam salisilat 3 %, serta diedukasi untuk menghindari gesekan pada lesi. Pasien mengaku gatal berkurang, namun tidak didapatkan perbaikan pada lesi.

Hasil: Berdasarkan usia dan jenis kelamin, pasien termasuk kelompok yang jarang terjadi liken amiloidosis. Kulit pasien tergolong dalam fototipe IV merupakan faktor risiko pada pasien. Pasien menyangkal adanya riwayat gesekan kronis. Diagnosis liken amyloidosis didasarkan lesi yang khas dengan lokasi sesuai predileksi dan diagnosis ditegakkan melalui pemeriksaan histopatologis dengan pewarnaan H&E. Terapi desoksimetason dan asam salisilat topikal tidak menunjukkan perbaikan secara klinis.

Kesimpulan: Pewarnaan H&E dapat mendemonstrasikan deposit amiloid dengan baik. Terapi amiloidosis kutaneus umumnya tidak memuaskan dan mungkin membutuhkan kombinasi berbagai modalitas terapi.

Acute thromboembolic ischemic stroke in rural hospital, the role of early treatment in reducing brain damage

Introduction: Stroke has a high mortality and disability rate, and the main cause of physical disability in productive age and elderly. In developed countries stroke is the number one cause of admission of patients to hospital, with a mortality proportion of 20%  within the first 28 days of treatment

Case Report: A 45-year-old man came to the neurology polyclinic of RSUD Aceh Besar on March 21^st, 2021 with chief complaints of the general weakness of the left limb, complete numbness and heavy feeling in the left limb since 4 hours of before admission which is felt to be getting weaker from time to time, happened suddenly when the patient was working collecting stones. He complained of dizziness as well, and did not decrease while resting. After the attack, the patient remains conscious with no headache, no nausea and vomiting, no double images were seen. On Siriraj score showed result of -4. The patient was hospitalized with injection of Citicolin 1000 mg and then discharged 5 days later with significant improvement.

Conclusion: Ischemic Stroke requires fast, precise and accurate handling to prevent and avoid disability and even death. One of the effective efforts is to organize health promotion and preventive programs starting from the First Level Health Facility (FKTP) on an ongoing basis to the community.

Herpes zoster oftalmikus dengan komplikasi okular: Laporan kasus

Background: Herpes zoster ophthalmicus occurs in 10-20% of cases of herpes zoster. Herpes zoster ophthalmicus occurs when the human herpes virus type 3 reactivates the first division of the trigeminal nerve, which is also called the ophthalmic division. In some patients, it may show ocular involvement.

Case: A 60 years old male patient came with swelling and wounds on the left forehead and around the left eye. Initially appear as watery spots and accompanied by pain. The pain felt like being stabbed, hot like burning sensation. The patient had chickenpox as a child. In the dermatological status of the superior palpebra, frontalis and left parietalis, multiple erythema patches were seen with multiple erosions. It appears that the lesion is unilaterally distributed according to the dermatome of the trigeminal cranial nerve of the left ophthalmic branch. Gram examination on erosive lesions showed the presence of 1-5 leukocytes / large field of view with Gram positive cocci and no Gram negative rods. The patient was diagnosed with herpes zoster ophthalmicus left with secondary infection. Consultation to ophthalmology division revealed left ocular herpes zoster ophthalmic (blepharoconjunctivitis), corneal erosions, iridoplegia and mature senile cataracts. The patient discharged on the fifth day. On the 11^th day, complaints of watery eyes, swelling and eye discharge were gone.

Conclusion: A case of herpes zoster ophthalmicus in old age with ocular complications and secondary infection was reported. For erosional lesions, open compresses was applied with NaCl and sodium fusidate cream. Patients respond well to therapy.

Latar Belakang: Herpes zoster oftalmikus terjadi pada 10-20% dari kasus herpes zoster. Herpes zoster oftalmikus terjadi ketika human herpes virus tipe 3 mengalami reaktivasi pada divisi pertama dari saraf trigeminalis, yang disebut juga divisi oftalmik. Pada beberapa pasien, dapat menunjukkan keterlibatan okular.

Laporan Kasus: Pasien laki-laki, usia 60 tahun datang dengan keluhan bengkak dan luka pada dahi kiri serta area sekitar mata kiri. Awalnya muncul berupa bintik-bintik berair dan disertai nyeri. Nyeri dirasakan seperti ditusuk-tusuk, panas seperti terbakar, dan mata terasa seperti tertarik. Pasien pernah menderita penyakit cacar air pada saat kanak-kanak. Pada status dermatologis palpebra superior, frontalis dan parietalis sinistra tampak patch eritema multipel dan pada beberapa tempat disertai erosi multipel. Tampak lesi terdistribusi secara unilateral sesuai dermatom nervus kranial trigeminus cabang oftalmikus sinistra. Pemeriksaan Gram pada lesi erosi menunjukkan adanya leukosit 1-5/lapang pandang besar, ditemukan adanya kokus Gram positif dan tidak didapatkan batang Gram negatif. Pasien didiagnosis dengan herpes zoster oftalmikus sinistra disertai infeksi sekunder. Konsultasi pada bagian mata didapatkan okuli sinistra herpes zoster optalmika (blefarokonjungtivitis), erosi kornea, iridoplegia dan katarak sinilis matur. Pasien dipulangkan pada hari kelima perawatan. Pada hari ke 11, Keluhan mata berair, bengkak dan kotoran mata sudah tidak ada.

Simpulan: Telah dilaporkan sebuah kasus herpes zoster oftalmikus pada usia tua dengan komplikasi okular dan didapatkan juga infeksi sekunder. Pada lesi erosi diberikan kompres terbuka dengan NaCl dan krim natrium fusidat. Pasien memberikan respon yang baik dengan terapi.